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Chakraborty P, Bokhari MM, Massé S, Azam MA, Lai PFH, Liang T, Si D, Bhaskaran A, Riazi S, Billia F, Nanthakumar K. Acute effects of dantrolene on the mechanical performance of myopathic human hearts. Heart Rhythm 2024:S1547-5271(24)02310-5. [PMID: 38574788 DOI: 10.1016/j.hrthm.2024.03.1815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Praloy Chakraborty
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mahmoud M Bokhari
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stéphane Massé
- The Hull Family Cardiac Fibrillation Management Laboratory, University Health Network, Toronto, Ontario, Canada
| | - Mohammed A Azam
- The Hull Family Cardiac Fibrillation Management Laboratory, University Health Network, Toronto, Ontario, Canada
| | - Patrick F H Lai
- The Hull Family Cardiac Fibrillation Management Laboratory, University Health Network, Toronto, Ontario, Canada
| | - Timothy Liang
- The Hull Family Cardiac Fibrillation Management Laboratory, University Health Network, Toronto, Ontario, Canada
| | - Daoyuan Si
- The Hull Family Cardiac Fibrillation Management Laboratory, University Health Network, Toronto, Ontario, Canada
| | - Abhishek Bhaskaran
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sheila Riazi
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Filio Billia
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; The Hull Family Cardiac Fibrillation Management Laboratory, University Health Network, Toronto, Ontario, Canada.
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Anderson RD, Bhaskaran A, Ha ACT, Nanthakumar K. Two ripples in a pond: The subtleties of mapping observations in localizing premature ventricular complex sites. J Cardiovasc Electrophysiol 2023; 34:1787-1788. [PMID: 37453071 DOI: 10.1111/jce.15986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Robert D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Abhishek Bhaskaran
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Andrew C T Ha
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Mumtaz M, Downar E, Kawada S, Zammit-Burg M, Anderson R, Massé S, Nair MKK, Nanthakumar J, Ghauri FM, Sánchez AP, Bhaskaran A. Utility of Substrate Mapping Using Extrasystole to Localise Comprehensive Ventricular Tachycardia Circuits: Results From Intra-operative Mapping Studies. Can J Cardiol 2023; 39:912-921. [PMID: 36918097 DOI: 10.1016/j.cjca.2023.02.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/28/2023] [Accepted: 02/21/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Substrate mapping-based identification of all ventricular tachycardia (VT) circuits (diastolic activation), including partial and complete diastolic circuits in clinical and nonclinical VT, could be beneficial in guiding VT ablation to prevent VT recurrence. The utility of extrasystole induced late potentials has not been compared with late potentials in sinus rhythm (SR) and right ventricular pacing (RVp). METHODS Intraoperative simultaneous panoramic endocardial mapping of 21 VTs in 16 ischemic heart disease patients was performed with the use of a 112-bipole endocardial balloon. The decrement of near-field electrogram later than surface QRS during extrasystole (eLP) was studied. RESULTS Patients had a mean age of 52 ± 9 years and were predominantly (75%) male. The mean sensitivity of eLP (0.75 [95% confidence interval [CI] 0.72-0.78]) to detect VT circuits was better than SR (0.33 [0.30-0.36]; P < 0.001) and RVp (0.36 [0.33-0.39]; P < 0.001) without significant differences in specificity, eLP (0.77 [0.74-0.81], SR (0.82 [0.80-0.84]; P = 0.23), and RVp (0.81 [0.78-0.83]; P = 0.11). Both negative (NPV) and positivie (PPV) predictive values were significantly better for eLP mapping. The mean NPV was 0.77 (95% CI 0.74-0.81), 0.57 (0.55-0.59), and 0.58 (0.55-0.61) for eLP, SR, and RVp, respectively (P < 0.0001). PPV was 0.75 (95% CI 0.72-0.78), 0.63 (0.59-0.67), and 0.63 (0.59-0.67) for eLP, SR, and RVp, respectively (P < 0.001). Overall diagnostic performance (area under the receiver operating characteristic curve) was significantly better for eLP (0.85 [95% CI 0.80-0.90] compared with SR (0.63 [0.56-0.72]; P < 0.001) or RVp (0.61 [0.52-0.74]; P < 0.001). CONCLUSIONS Evoked late potential mapping is a better tool to detect comprehensive diastolic circuits activated during VT, compared with eLP mapping in sinus rhythm or RV pacing.
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Affiliation(s)
- Maroosh Mumtaz
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada; Department of Medicine, Cardiology, University of Toronto, Ontario, Canada
| | - Eugene Downar
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Satoshi Kawada
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Melanie Zammit-Burg
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Robert Anderson
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Stéphane Massé
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Madhav Krishna Kumar Nair
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Jared Nanthakumar
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | | | - Andreu Porta- Sánchez
- Arrhythmia Unit, Hospital Universitario Quirónsalud Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain.
| | - Abhishek Bhaskaran
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada.
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Charanya C, Sampathkrishnan S, Kumutha R, Praveena J, Bhaskaran A, Prabakaran A, Balamurugan N. Synthesis, Quantum Computational Analysis and Molecular Docking of 3-(2-Hydroxyphenyl)-1-Phenyl Propanone: A Combined Experimental and Theoretical Analysis. Polycycl Aromat Compd 2023. [DOI: 10.1080/10406638.2022.2157025] [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: 01/24/2023]
Affiliation(s)
- C. Charanya
- Department of Applied Physics, Sri Venkateshwara College of Engineering, Sriperumbudur, India
| | - S. Sampathkrishnan
- Department of Applied Physics, Sri Venkateshwara College of Engineering, Sriperumbudur, India
| | - R. Kumutha
- Department of Physics, S.A. Engineering College, Chennai, India
| | - J. Praveena
- Department of Physics, Bon Secours Arts and Science College for Women, Mannargudi, India
| | - A. Bhaskaran
- Department of Applied Physics, Sri Venkateshwara College of Engineering, Sriperumbudur, India
| | - A. Prabakaran
- Department of Applied Physics, Vel Tech Rangarajan Dr. Sagunthala R&D Institute of Science and Technology, Chennai, India
| | - N. Balamurugan
- Department of Physics, Bharath Institute of Higher Education and Research, Chennai, India
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Padilla JR, Anderson RD, Joens C, Masse S, Bhaskaran A, Niri A, Lai P, Azam MA, Lee G, Vigmond E, Nanthakumar K. Orientation of conduction velocity vectors on cardiac mapping surfaces. Europace 2023; 25:1172-1182. [PMID: 36609707 PMCID: PMC10062359 DOI: 10.1093/europace/euac259] [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] [Received: 08/30/2022] [Accepted: 12/06/2022] [Indexed: 01/09/2023] Open
Abstract
AIMS Electroanatomical maps using automated conduction velocity (CV) algorithms are now being calculated using two-dimensional (2D) mapping tools. We studied the accuracy of mapping surface 2D CV, compared to the three-dimensional (3D) vectors, and the influence of mapping resolution in non-scarred animal and human heart models. METHODS AND RESULTS Two models were used: a healthy porcine Langendorff model with transmural needle electrodes and a computer stimulation model of the ventricles built from an MRI-segmented, excised human heart. Local activation times (LATs) within the 3D volume of the mesh were used to calculate true 3D CVs (direction and velocity) for different pixel resolutions ranging between 500 μm and 4 mm (3D CVs). CV was also calculated for endocardial surface-only LATs (2D CV). In the experimental model, surface (2D) CV was faster on the epicardium (0.509 m/s) compared to the endocardium (0.262 m/s). In stimulation models, 2D CV significantly exceeded 3D CVs across all mapping resolutions and increased as resolution decreased. Three-dimensional and 2D left ventricle CV at 500 μm resolution increased from 429.2 ± 189.3 to 527.7 ± 253.8 mm/s (P < 0.01), respectively, with modest correlation (R = 0.64). Decreasing the resolution to 4 mm significantly increased 2D CV and weakened the correlation (R = 0.46). The majority of CV vectors were not parallel (<30°) to the mapping surface providing a potential mechanistic explanation for erroneous LAT-based CV over-estimation. CONCLUSION Ventricular CV is overestimated when using 2D LAT-based CV calculation of the mapping surface and significantly compounded by mapping resolution. Three-dimensional electric field-based approaches are needed in mapping true CV on mapping surfaces.
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Affiliation(s)
| | - Robert D Anderson
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
| | - Christian Joens
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
| | - Stephane Masse
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
| | - Abhishek Bhaskaran
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
| | - Ahmed Niri
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
| | - Patrick Lai
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
| | - Mohammed Ali Azam
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | | - Kumaraswamy Nanthakumar
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526, Toronto, Ontario M5G 2C4, Canada
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Rahimi M, Anderson RD, Ha ACT, Bhaskaran A. Phase 4 Atrioventricular Block After Transcatheter Aortic Valve Replacement. Can J Cardiol 2023; 39:20-21. [PMID: 36377110 DOI: 10.1016/j.cjca.2022.10.024] [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] [Received: 08/04/2022] [Revised: 09/15/2022] [Accepted: 10/07/2022] [Indexed: 01/13/2023] Open
Affiliation(s)
- Mahbod Rahimi
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Robert D Anderson
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Andrew C T Ha
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Abhishek Bhaskaran
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto, Ontario, Canada.
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Muthulakshmi G, Mohamed Ismail M, Ramya R, Arivanandhan M, Arjunan S, Bhaskaran A. Facile preparation of SnO2/MoS2 nanocomposites with high electrochemical performance for energy storage applications. INORG CHEM COMMUN 2022. [DOI: 10.1016/j.inoche.2022.109802] [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: 11/05/2022]
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Anderson RD, Rodriguez Padilla J, Joens C, Masse S, Bhaskaran A, Magtibay K, Niri A, Asta J, Lai P, Azam MA, Vigmond E, Nanthakumar K. On the Electrophysiology and Mapping of Intramural Arrhythmic Focus. Circ Arrhythm Electrophysiol 2022; 15:e010384. [PMID: 35323037 DOI: 10.1161/circep.121.010384] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conventional mapping of focal ventricular arrhythmias relies on unipolar electrogram characteristics and early local activation times. Deep intramural foci are common and associated with high recurrence rates following catheter-based radiofrequency ablation. We assessed the accuracy of unipolar morphological patterns and mapping surface indices to predict the site and depth of ventricular arrhythmogenic focal sources. METHODS An experimental beating-heart model used Langendorff-perfused, healthy swine hearts. A custom 56-pole electrode array catheter was positioned on the left ventricle. A plunge needle was placed perpendicular in the center of the grid to simulate arrhythmic foci at variable depths. Unipolar electrograms and local activation times were generated. Simulation models from 2 human hearts were also included with grids positioned simultaneously on the endocardium-epicardium from multiple left ventricular, septal, and outflow tract sites. RESULTS A unipolar Q or QS complex lacks specificity for superficial arrhythmic foci, as this morphology pattern occupies a large surface area and is the predominant pattern as intramural depth increases without developing a R component. There is progressive displacement from the arrhythmic focus to the surface exit as intramural focus depth increases. A shorter total activation time over the overlying electrode array, larger surface area within initial 20 ms activation, and a dual surface breakout pattern all indicate a deep focus. CONCLUSIONS Displacement from the focal intramural origin to the exit site on the mapping surface could lead to erroneous lesion delivery strategies. Traditional unipolar electrogram features lack specificity to predict the intramural arrhythmic source; however, novel endocardial-epicardial mapping surface indices can be used to determine the depth of arrhythmic foci.
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Affiliation(s)
- Robert D Anderson
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | | | - Christian Joens
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Stephane Masse
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Abhishek Bhaskaran
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Karl Magtibay
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Ahmed Niri
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - John Asta
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Patrick Lai
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Mohammed Ali Azam
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Edward Vigmond
- IHU Liryc, Hôpital Xavier Arnozan, Pessac Cedex, France (J.R.P., E.V.)
| | - Kumaraswamy Nanthakumar
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
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Zhou Y, Campbell T, Bhaskaran A, De Silva K, Turnbull S, Wong M, Kumar S. Systematic Review on Quality-of-Life Post Catheter Ablation for Non-Atrial Fibrillation Arrhythmias. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.196] [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: 10/16/2022]
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Butters A, Do J, Stafford F, Krishnan N, Brown J, Hespe S, Richardson E, Bagnall R, Bhaskaran A, Burns C, Driscoll T, Fatkin D, Gray B, Iglesias C, Isbister J, Jabbour A, Johnson R, Kumar S, Leslie F, MacArthur D, Nowak N, Pouliopoulos J, Puranik R, Semsarian C, Sweeting J, Sy R, Ugander M, Yeates L, Ingles J. NSW HEARTS: The NSW Inherited Cardiomyopathy Cohort Study protocol. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.04.010] [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: 11/16/2022]
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Niri A, Shapira E, Masse S, Bar-tal M, Bar-on T, Hayam G, Ben-dor A, Bhaskaran A, Nanthakumar K, Nair K. B-PO05-172 AUTOMATED IDENTIFICATION OF VT ABLATION TARGETS: MULTICENTER VALIDATION AND WORKFLOW CHARACTERIZATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1091] [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: 10/20/2022]
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Bhaskaran A, Liang T, Niri A, Azam MA, Massé S, Asta J, Magtibay K, Lai PFH, Labos C, Ha ACT, Nanthakumar K. Multi-Axis Lead with Tetrahedral Electrode Tip for Cardiac Implantable Devices: Creative Concept for Pacing and Sensing Technology. Can J Cardiol 2021; 37:1808-1817. [PMID: 34333028 DOI: 10.1016/j.cjca.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We developed a multi-axis lead (MaxLead) incorporating four electrodes arranged at the lead-tip organized in an equidistant tetrahedron. Here, we studied MaxLead performance in sensing, pacing and activation wavefront-direction analysis. METHODS Sixteen explanted animal hearts (from 7 pigs, 7 sheep and 2 rabbits) were used. Pacing threshold was tested from all axes of MaxLead from RV apex before and after simulated dislodgement. Additionally, conduction-system pacing was performed in sheep heart preparations from all axes of MaxLead. Sensing via MaxLead positioned at RV apex was tested during sinus rhythm (SR), pacing from RV and LV free-wall, and ventricular fibrillation (VF). MaxLead-enabled voltage (MaxV), defined as the largest span of the sensed electric field loop, was compared to traditional lead-tip voltage detection. RESULTS Pacing: MaxLead minimized change in pacing threshold due to lead-dislodgement (average voltage change 0.2 mV, 95% CI (-0.5, 0.9)), using multiple bipoles available for pacing. In animals with high conduction system pacing thresholds (>2mV) in one or more bipoles (3/7), acceptable thresholds (<1 mV) were demonstrated in an average of 2.5 remaining bipoles. Sensing: MaxV of SR and VF was consistently higher than the highest bipolar voltage (voltage difference averaged -0.18 mV, 95% confidence interval (CI: -0.28 to -0.07), p=0.001). Electric field loop geometry consistently differentiated ventricular activation in SR from that during pacing from RV and LV free walls. CONCLUSIONS The multi-axis MaxLead electrode showed advantages in pacing, sensing and mapping and has the potential to allow for improvements in lead/electrode technology for cardiac implanted electronic devices.
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Affiliation(s)
- Abhishek Bhaskaran
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Timothy Liang
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ahmed Niri
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Mohammed Ali Azam
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Stéphane Massé
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - John Asta
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Karl Magtibay
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Patrick F H Lai
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Andrew C T Ha
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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Downar E, Janse MJ, Bhaskaran A, Niri A, Velluppillai A, Massé S, Nanthakumar K. High density intramural mapping of post-infarct premature ventricular contractions and ventricular tachycardia. Pacing Clin Electrophysiol 2021; 44:1781-1785. [PMID: 34314041 DOI: 10.1111/pace.14326] [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] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/07/2021] [Accepted: 07/25/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Spontaneous ventricular premature contractions (PVCs) and ventricular tachycardia (VT) in the acute post infarct milieu is assumed to be due to automaticity. However, the mechanism has not been studied with intramural mapping. OBJECTIVE To study the mechanism of spontaneous PVCs with high density intramural mapping in a canine model, and to test the hypothesis that post-infarct PVCs and VT are due to re-entry rather than automaticity. METHODS In 15 anesthetized dogs, using 768 intramural unipolar electrograms, simultaneous recordings were made. After 20 min of stabilization, recordings were made during the first 10 min of ischemia, and activation maps of individual beats were constructed. Acute ischemia was produced by clamping the left anterior descending coronary artery proximal to the first diagonal branch. RESULTS In all experiments ST-T alternans was present. Spontaneous ventricular beats occurred in five of 15 dogs where the earliest ectopic activity was manifested in the endocardium, well within the ischemic zone. From there, activity spread rapidly along the subendocardium, with endo-to epicardial spread along the non-ischemic myocardium. Epicardial breakthrough always occurred at the border of the ischemic myocardium. In three dogs, delayed potentials were observed, which were earliest at the ischemic epicardium and extended transmurally with increasing delay towards the endocardium, where they culminated in a premature beat. A similar sequence was observed in VT that followed. CONCLUSION Graded responses that occur with each sinus beat intramurally, when able to propagate from epicardium to endocardium are the mechanism of PVCs and VT in post-infarct myocardium.
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Affiliation(s)
- Eugene Downar
- Division of Cardiology. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michiel J Janse
- Experimental and Molecular Cardiology Group, Academic Medical Center, Amsterdam, Netherlands
| | - Abhishek Bhaskaran
- Division of Cardiology. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ahmed Niri
- Division of Cardiology. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Arulalan Velluppillai
- Division of Cardiology. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Stéphane Massé
- Division of Cardiology. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- Division of Cardiology. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Bhaskaran A, Niri A, Azam MA, Nayyar S, Porta-Sánchez A, Massé S, Liang T, Veluppillai A, Du B, Lai PFH, Ha A, Nanthakumar K. Safety, efficacy, and monitoring of bipolar radiofrequency ablation in beating myopathic human and healthy swine hearts. Heart Rhythm 2021; 18:1772-1779. [PMID: 34182170 DOI: 10.1016/j.hrthm.2021.06.1189] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The safety and efficacy parameters for bipolar radiofrequency (RF) ablation are not well defined. OBJECTIVE The purpose of this study was to investigate the safe range of power, utility of transmyocardial bipolar electrogram (EGM) amplitude, and circuit impedance in ablation monitoring. METHODS Sixteen beating ex vivo human and swine hearts were studied in a Langendorff setup. Ninety-two bipolar ablations using two 4-mm irrigated catheters were performed at settings of 20-50 W, 60 seconds, and 30 mL/min irrigation in the left ventricle. RESULTS For low-power ablations (20 and 30 W), transmurality was observed in 29 of 38 (76%) and 10 of 28 (36%) ablations for tissue thickness ≤17 mm and >17 mm, respectively. For high-power ablations (40 and 50 W), transmurality was observed in 5 of 7 (71%) and 7 of 19 (37%) ablations for tissue thickness ≤17 mm and >17 mm, respectively. Steam pop occurrence for low- and high-power ablations was 11 of 66 (16%) and 16 of 26 (62%), respectively (P = .0001), respectively. Lesion depth (limited by transmurality) was 12.0 ± 5.7 mm and 12.3 ± 5.8 mm, respectively (P = 1). Transmyocardial EGM amplitude decrement >60% strongly predicted transmurality (area under the curve [AUC] 0.8), and circuit impedance decrement >26% predicted steam pops (AUC 0.75). Half-normal saline did not affect transmurality or incidence of steam pops compared to normal saline irrigation. CONCLUSION Bipolar RF ablation at power of 20-30 W provided an ideal balance of safety and efficacy, whereas power ≥40 W should be used with caution due to the high incidence of steam pops. Lesion transmurality monitoring and steam pop avoidance were best achieved using transmyocardial bipolar EGM voltage and circuit impedance, respectively.
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Affiliation(s)
- Abhishek Bhaskaran
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Ahmed Niri
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Mohammed Ali Azam
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Sachin Nayyar
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Andreu Porta-Sánchez
- Arrhythmia Unit, Hospital Universitario Quirónsalud Madrid, Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC)
| | - Stéphane Massé
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Timothy Liang
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Arulalan Veluppillai
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Beibei Du
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Patrick F H Lai
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Andrew Ha
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada.
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15
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Rajasekar G, Dhatchaiyini M, Bhaskaran A. Crystal growth, structural, optical, laser damage threshold, mechanical and DFT studies on a new metal-organic framework: Potassium boro (hemi) fumarate. J Mol Struct 2021. [DOI: 10.1016/j.molstruc.2020.129663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Glicksman RM, Bhaskaran A, Nanthakumar K, Lindsay P, Coolens C, Conroy L, Letourneau D, Lok BH, Giuliani M, Hope A. Implementation of Cardiac Stereotactic Radiotherapy: From Literature to the Linac. Cureus 2021; 13:e13606. [PMID: 33816005 PMCID: PMC8011471 DOI: 10.7759/cureus.13606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Stereotactic radiotherapy (SBRT) has been applied to treat cardiac arrhythmias, but our institution had not yet implemented this technique. Here, we explain how we used implementation science and knowledge translation to provide cardiac SBRT to a critically ill patient with malignancy-associated refractory ventricular tachycardia. We reviewed the critical factors that enabled the implementation of this urgent treatment, such as the context of the implementation, the characteristics of the intervention, and the stakeholders. These principles can be used by other radiation programs to implement novel treatments in urgent settings, where the gold standard process of planning and developing policies and protocols is not possible.
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Affiliation(s)
- Rachel M Glicksman
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Abhishek Bhaskaran
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, CAN
| | - Kumaraswamy Nanthakumar
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, CAN
| | - Patricia Lindsay
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Catherine Coolens
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Leigh Conroy
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Daniel Letourneau
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Benjamin H Lok
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Meredith Giuliani
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Andrew Hope
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
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17
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Bhaskaran A, Fitzgerald J, Jackson N, Gizurarson S, Nanthakumar K, Porta-Sánchez A. Decrement Evoked Potential Mapping to Guide Ventricular Tachycardia Ablation: Elucidating the Functional Substrate. Arrhythm Electrophysiol Rev 2020; 9:211-218. [PMID: 33437489 PMCID: PMC7788395 DOI: 10.15420/aer.2020.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Empirical approaches to targeting the ventricular tachycardia (VT) substrate include mapping of late potentials, local abnormal electrogram, pace-mapping and homogenisation of the abnormal signals. These approaches do not try to differentiate between the passive or active role of local signals as the critical components of the VT circuit. By not considering the functional components, these approaches often view the substrate as a fixed anatomical barrier. Strategies to improve the success of VT ablation need to include the identification of critical functional substrate. Decrement-evoked potential (DeEP) mapping has been developed to elucidate this using an extra-stimulus added to a pacing drive train. With knowledge translation in mind, the authors detail the evolution of the DeEP concept by way of a study of simultaneous panoramic endocardial mapping in VT ablation; an in silico modelling study to demonstrate the factors influencing DeEPs; a multicentre VT ablation validation study; a practical approach to DeEP mapping; the potential utility of DeEPs to identify arrhythmogenic atrial substrate; and, finally, other functional mapping strategies.
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Affiliation(s)
| | | | | | | | | | - Andreu Porta-Sánchez
- Hospital Universitario Quirónsalud Madrid, Molecular Cardiology Laboratory, Centro Nacional de Investigaciones Cardiovasculares, Spain
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18
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Si D, Du B, Ni L, Yang B, Sun H, Jiang N, Liu G, Massé S, Jin L, Nanthakumar J, Bhaskaran A, Yang P, Nanthakumar K. Mortalité, congé et arythmie chez les patients ayant la COVID-19 et une atteinte cardiaque. CMAJ 2020; 192:E1648-E1656. [DOI: 10.1503/cmaj.200879-f] [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] [Accepted: 06/09/2020] [Indexed: 11/01/2022] Open
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19
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Porta-Sánchez A, Magtibay K, Nayyar S, Bhaskaran A, Lai PFH, Massé S, Labos C, Qiang B, Romagnuolo R, Masoudpour H, Biswas L, Ghugre N, Laflamme M, Deno DC, Nanthakumar K. Omnipolarity applied to equi-spaced electrode array for ventricular tachycardia substrate mapping. Europace 2020; 21:813-821. [PMID: 30726937 PMCID: PMC6479413 DOI: 10.1093/europace/euy304] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 08/28/2018] [Accepted: 12/04/2018] [Indexed: 11/17/2022] Open
Abstract
Aims Bipolar electrogram (BiEGM)-based substrate maps are heavily influenced by direction of a wavefront to the mapping bipole. In this study, we evaluate high-resolution, orientation-independent peak-to-peak voltage (Vpp) maps obtained with an equi-spaced electrode array and omnipolar EGMs (OTEGMs), measure its beat-to-beat consistency, and assess its ability to delineate diseased areas within the myocardium compared against traditional BiEGMs on two orientations: along (AL) and across (AC) array splines. Methods and results The endocardium of the left ventricle of 10 pigs (three healthy and seven infarcted) were each mapped using an Advisor™ HD grid with a research EnSite Precision™ system. Cardiac magnetic resonance images with late gadolinium enhancement were registered with electroanatomical maps and were used for gross scar delineation. Over healthy areas, OTEGM Vpp values are larger than AL bipoles by 27% and AC bipoles by 26%, and over infarcted areas OTEGM Vpp values are 23% larger than AL bipoles and 27% larger than AC bipoles (P < 0.05). Omnipolar EGM voltage maps were 37% denser than BiEGM maps. In addition, OTEGM Vpp values are more consistent than bipolar Vpps showing less beat-by-beat variation than BiEGM by 39% and 47% over both infarcted and healthy areas, respectively (P < 0.01). Omnipolar EGM better delineate infarcted areas than traditional BiEGMs from both orientations. Conclusion An equi-spaced electrode grid when combined with omnipolar methodology yielded the largest detectable bipolar-like voltage and is void of directional influences, providing reliable voltage assessment within infarcted and non-infarcted regions of the heart.
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Affiliation(s)
- Andreu Porta-Sánchez
- Dept de Medicina, Universitat de Barcelona, Barcelona and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Karl Magtibay
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Sachin Nayyar
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Abhishek Bhaskaran
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Patrick F H Lai
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Stéphane Massé
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Christopher Labos
- Office for Science and Society, McGill University, Montreal, Quebec, Canada
| | - Beiping Qiang
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rocco Romagnuolo
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Hassan Masoudpour
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Nilesh Ghugre
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Michael Laflamme
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Kumaraswamy Nanthakumar
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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20
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Samanta R, Ng B, Ha A, Bhaskaran A, Bokhari M, Nair K, Nanthakumar K. Minimalistic strategy for coronary sinus lead implant: A single tool capable of electrophysiological mapping, pressure measurement, and angiography. Pacing Clin Electrophysiol 2020; 43:1072-1077. [PMID: 32632946 DOI: 10.1111/pace.14005] [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] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/25/2020] [Accepted: 07/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Left ventricular (LV) lead implantation for cardiac resynchronization therapy (CRT) may be confounded by contrast load during attempted cannulation and lead dislodgement during guiding catheter splitting. An LV lead implant system with a steerable single catheter that completely avoids the use of guiding catheters when needed, acquires atrioventricular electrograms, measures intracardiac pressures, permits CS angiography, and has the ability to direct a coronary angioplasty wire that will lead the final delivery of LV lead into a CS tributary, may help limit contrast use and avoid lead dislodgement at CS guide sheath removal. METHODS AND RESULTS In this article as a proof of concept, we describe the use of this minimalist technique as a first line approach in six patients who had standard indications for CRT. The LV lead was successfully implanted in a target vein in all patients without acute complications. Contrast was not used in half the group and the LV lead was successfully implanted without guiding catheter in four patients. The implantation technique evolved through the series and in the final patient, no guiding sheath or contrast was used. Postimplant lead positions on chest X-ray and lead parameters were stable in all patients at follow-up. CONCLUSION In proof of concept paper, we describe a technique of LV lead implantation potentially without the use of contrast and standard CS guiding catheters. Once familiar, this approach may provide a less complicated strategy.
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Affiliation(s)
- Rahul Samanta
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ben Ng
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Andrew Ha
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Abhishek Bhaskaran
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Mahmoud Bokhari
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Krishnakumar Nair
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
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21
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Bokhari MM, Bhaskaran A, Gorth G, Massé S, Downer E, Nanthakumar K. Trans‐myocardial bipolar electrogram: A strategy for mapping and determining efficacy of bipolar ablation of deep foci. Pacing Clin Electrophysiol 2020; 43:760-762. [DOI: 10.1111/pace.13907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/01/2020] [Accepted: 02/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Mahmoud M. Bokhari
- Toronto General HospitalUniversity Health Network Toronto Ontario Canada
| | - Abhishek Bhaskaran
- Toronto General HospitalUniversity Health Network Toronto Ontario Canada
| | - Gregory Gorth
- Toronto General HospitalUniversity Health Network Toronto Ontario Canada
| | - Stéphane Massé
- The Hull Family Cardiac Fibrillation Management LaboratoryUniversity Health Network Toronto Ontario Canada
| | - Eugene Downer
- Toronto General HospitalUniversity Health Network Toronto Ontario Canada
| | - Kumaraswamy Nanthakumar
- Toronto General HospitalUniversity Health Network Toronto Ontario Canada
- The Hull Family Cardiac Fibrillation Management LaboratoryUniversity Health Network Toronto Ontario Canada
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22
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Si D, Du B, Ni L, Yang B, Sun H, Jiang N, Liu G, Massé S, Jin L, Nanthakumar J, Bhaskaran A, Yang P, Nanthakumar K. Death, discharge and arrhythmias among patients with COVID-19 and cardiac injury. CMAJ 2020; 192:E791-E798. [PMID: 32586839 DOI: 10.1503/cmaj.200879] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cardiac injury is common in severe coronavirus disease 2019 (COVID-19) and is associated with poor outcomes. We aimed to study predictors of in-hospital death, characteristics of arrhythmias and the effects of QT-prolonging therapy in patients with cardiac injury. METHODS We conducted a retrospective cohort study involving patients with severe COVID-19 who were admitted to Tongji Hospital in Wuhan, China, between Jan. 29 and Mar. 8, 2020. Among patients who had cardiac injury, which we defined as an elevated level of cardiac troponin I (cTnI), we identified demographic and clinical characteristics associated with mortality and need for invasive ventilation. RESULTS Among 1284 patients with severe COVID-19, 1159 had a cTnI level measured on admission to hospital, of whom 170 (14.7%) had results that showed cardiac injury. We found that mortality was markedly higher in patients with cardiac injury (71.2% v. 6.6%, p < 0.001). We determined that initial cTnI (per 10-fold increase, hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.06-1.66) and peak cTnI level during illness (per 10-fold increase, HR 1.70, 95% CI 1.38-2.10) were associated with poor survival. Peak cTnI was also associated with the need for invasive ventilation (odds ratio 3.02, 95% CI 1.92-4.98). We found arrhythmias in 44 of the 170 patients with cardiac injury (25.9%), including 6 patients with ventricular tachycardia or fibrillation, all of whom died. We determined that patients who received QT-prolonging drugs had longer QTc intervals than those who did not receive them (difference in medians, 45 ms, p = 0.01), but such treatment was not independently associated with mortality (HR 1.04, 95% CI 0.69-1.57). INTERPRETATION We found that in patients with COVID-19 and cardiac injury, initial and peak cTnI levels were associated with poor survival, and peak cTnI was a predictor of need for invasive ventilation. Patients with COVID-19 warrant assessment for cardiac injury and monitoring, especially if therapy that can prolong repolarization is started. TRIAL REGISTRATION Chinese Clinical Trial Registry, No. ChiCTR2000031301.
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Affiliation(s)
- Daoyuan Si
- Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China
| | - Beibei Du
- Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China
| | - Lujia Ni
- Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China
| | - Bo Yang
- Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China
| | - Huan Sun
- Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China
| | - Nan Jiang
- Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China
| | - Guohui Liu
- Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China
| | - Stéphane Massé
- Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China
| | - Lina Jin
- Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China
| | - Jared Nanthakumar
- Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China
| | - Abhishek Bhaskaran
- Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China
| | - Ping Yang
- Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China
| | - Kumaraswamy Nanthakumar
- Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China
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Kawada S, Chakraborty P, Albertini L, Bhaskaran A, Oechslin EN, Sliversides C, Wald RM, Roche SL, Harris L, Swan L, Alonso-Gonzalez R, Thorne S, Downar E, Nanthakumar K, Mondésert B, Khairy P, Nair K. Safety and Long-term Outcomes of Defibrillator Therapy in Patients With Right-Sided Implantable Cardiac Devices in Adults With Congenital Heart Disease. Can J Cardiol 2020; 37:407-416. [PMID: 32522524 DOI: 10.1016/j.cjca.2020.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/22/2020] [Accepted: 05/30/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) have been proven to prevent sudden cardiac death in adult congenital heart disease (ACHD) patients. Although the left side is chosen by default, implantation from the right side is often required. However, little is known about the efficacy and safety of right-sided ICDs in ACHD patients. METHODS In this study we reviewed a total of 191 ACHD patients undergoing ICD/cardioverter resynchronisation therapy-defibrillator (CRT-D) implantation at our hospital between 2001 and 2019 (134 men and 57 women; age [mean ± standard deviation], 41.5 ± 14.8 years). RESULTS Twenty-seven patients (14.1%) had right-sided devices. The most common causes of right-sided implantation were persistent left superior vena cava and vein occlusion (37.0%). Although procedure time (202.8 ± 60.5 minutes vs 143.8 ± 69.1 minutes, P = 0.008) was longer and the procedural success was lower (92.6% vs 99.4%, P = 0.008) for right-sided devices, no difference in R-wave and pacing threshold were noted. Among the 47 patients (24.6%) who underwent defibrillation threshold testing (DFT), no difference in DFT was observed (25.2 ± 5.3 J vs 23.8 ± 4.1 J, P = 0.460). During the median follow-up of 42.4 months, appropriate ICD therapy was observed in 5 (18.5%) and 30 (18.3%) patients for right- and left-sided ICDs/CRTDs, respectively (P = 0.978). No significant difference was seen in complications between them. CONCLUSIONS Implantation of an ICD on the right side is technically challenging, but it is feasible as an alternative approach for ACHD patients with contraindications to left-sided device implantation.
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Affiliation(s)
- Satoshi Kawada
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Praloy Chakraborty
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Lisa Albertini
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Abhishek Bhaskaran
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Erwin N Oechslin
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Candice Sliversides
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Rachel M Wald
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - S Lucy Roche
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Louise Harris
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Lorna Swan
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Rafael Alonso-Gonzalez
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Sara Thorne
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Eugene Downar
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Blandine Mondésert
- Department of Cardiology, Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
| | - Paul Khairy
- Department of Cardiology, Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
| | - Krishnakumar Nair
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada.
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24
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Deno DC, Bhaskaran A, Morgan DJ, Goksu F, Batman K, Olson GK, Magtibay K, Nayyar S, Porta-Sánchez A, Laflamme MA, Massé S, Aukhojee P, Nair K, Nanthakumar K. High-resolution, live, directional mapping. Heart Rhythm 2020; 17:1621-1628. [PMID: 32438020 DOI: 10.1016/j.hrthm.2020.04.039] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 04/23/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Affiliation(s)
- D Curtis Deno
- Cardiac Arrhythmias and Heart Failure Division, Abbott Laboratories, St. Paul, Minnesota
| | - Abhishek Bhaskaran
- Hull Family Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Dennis J Morgan
- Cardiac Arrhythmias and Heart Failure Division, Abbott Laboratories, St. Paul, Minnesota
| | - Fikri Goksu
- Department of Electrical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Katherine Batman
- Cardiac Arrhythmias and Heart Failure Division, Abbott Laboratories, St. Paul, Minnesota
| | - Gregory K Olson
- Cardiac Arrhythmias and Heart Failure Division, Abbott Laboratories, St. Paul, Minnesota
| | - Karl Magtibay
- Hull Family Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Sachin Nayyar
- Hull Family Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Michael A Laflamme
- Hull Family Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Stéphane Massé
- Hull Family Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Prashant Aukhojee
- Hull Family Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Krishnakumar Nair
- Hull Family Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- Hull Family Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada.
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25
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Bhaskaran A, Nayyar S, Porta-Sánchez A, Jons C, Massé S, Magtibay K, Aukhojee P, Ha A, Bokhari M, Tung R, Downar E, Nanthakumar K. Direct and indirect mapping of intramural space in ventricular tachycardia. Heart Rhythm 2020; 17:439-446. [DOI: 10.1016/j.hrthm.2019.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Indexed: 12/01/2022]
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26
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Bhaskaran A, Downar E, Chauhan VS, Lindsay P, Nair K, Ha A, Hope A, Nanthakumar K. Electroanatomical mapping-guided stereotactic radiotherapy for right ventricular tachycardia storm. HeartRhythm Case Rep 2019; 5:590-592. [PMID: 31890583 PMCID: PMC6926178 DOI: 10.1016/j.hrcr.2019.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Abhishek Bhaskaran
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Eugene Downar
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Vijay S Chauhan
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Patricia Lindsay
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Krishnakumar Nair
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Andrew Ha
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Andrew Hope
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Kumaraswamy Nanthakumar
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
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27
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Bhaskaran A, Nayyar S, Charla P, Saeed Y, Haldar S, Porta-Sánchez A, Kugamoorthy P, Hans A, Jons C, Oechslin E, Hickey E, Harris L, Silversides C, Roche SL, Downar E, Nanthakumar K, Nair K. Lateral tunnel Fontan atrial tachycardia ablation trans-baffle access is not mandatory as the initial strategy. J Interv Card Electrophysiol 2019; 58:299-306. [PMID: 31399922 DOI: 10.1007/s10840-019-00580-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/14/2019] [Accepted: 06/12/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mapping and ablation of atrial tachycardia (AT) is commonly performed in lateral tunnel Fontan (LTF) patients, yet there is little information on the need of baffle puncture to access the pulmonary venous atrium (PVA). This study aimed to evaluate the most common chamber location of critical sites for majority of AT in LTF patients. METHODS Consecutive LTF patients underwent catheter-based high-density mapping and ablation of AT from Nov. 2015 to Mar. 2019. Critical sites were identified by a combination of activation and entrainment mapping. Acute procedural success was defined as AT termination with ablation and non-inducibility of any AT. Predictors for ablation failure were evaluated in retrospect. RESULTS Fifteen catheter ablation procedures were performed in 9 patients. A total of 15 clinical ATs (mean TCL 369 ± 91 ms) were mapped. The mechanism was macro re-entry in 11 (73%) and micro re-entry in 2. In 11 ATs (73%), 94 ± 5% of tachycardia cycle length (TCL) were mapped inside the tunnel. The commonest site of successful ablation in the tunnel was on the lateral wall (60%). Trans-baffle access was obtained during 5 of 15 procedures (33%). Overall, procedural success was achieved in 9 of 15 procedures (60%). There were no complications. Recurrence of AT was 42% over a follow-up period of 4.3 ± 3.2 years. Faster TCL of 200-300 ms showed a trend towards ablation failure, (OR 17, 95% CI 0.7 to 423, p = 0.08). CONCLUSIONS Catheter ablation can be performed effectively for ATs in LTF patients usually from inside the tunnel. ATs with critical sites in the PVA are uncommon. This information will help plan ablation in LTF patients without resorting to initial trans-baffle access.
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Affiliation(s)
- Abhishek Bhaskaran
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Sachin Nayyar
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Pradeepkumar Charla
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Yawer Saeed
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Shouvik Haldar
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Andreu Porta-Sánchez
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Priyanka Kugamoorthy
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | | | - Christian Jons
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Erwin Oechslin
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Edward Hickey
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Louise Harris
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Candice Silversides
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - S Lucy Roche
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Eugene Downar
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Kumaraswamy Nanthakumar
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Krishnakumar Nair
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada.
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28
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Bhaskaran A, Gizurarson S, Porta-Sánchez A, Massé S, Nair K, Nanthakumar K. Atrial decremental evoked potentials accurately determine the critical isthmus of intra-atrial re-entrant tachycardia. Europace 2019; 20:1620. [PMID: 30085029 DOI: 10.1093/europace/euy164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
- Abhishek Bhaskaran
- Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526 Toronto, Ontario, Canada
| | - S Gizurarson
- Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526 Toronto, Ontario, Canada
| | - Andreu Porta-Sánchez
- Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526 Toronto, Ontario, Canada
| | - Stéphane Massé
- Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526 Toronto, Ontario, Canada
| | - Krishnakumar Nair
- Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526 Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, GW3-526 Toronto, Ontario, Canada
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29
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Rajasekar G, Dhatchaiyini M, Vinitha G, Bhaskaran A. Structural, optical, dielectric, second and third-order nonlinear properties of new semiorganic crystal: Sodium (bis) boro succinate. J Mol Struct 2019. [DOI: 10.1016/j.molstruc.2018.07.113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Dhatchaiyini MK, NizamMohideen M, Rajasekar G, Bhaskaran A. Dipotassium tetrahydroxidopentaoxidotetraborate monohydrate. IUCr Data 2019. [DOI: 10.1107/s2414314619001287] [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] [Indexed: 11/10/2022] Open
Abstract
In the tetraborate anion of the title compound, K2[B4O5(OH)4]·H2O, the bridging B—O bond lengths of the tetrahedral BO4 and the trigonal-planar BO3 units are slightly longer than the corresponding terminal B—OH bond lengths. The crystal structure is stabilized by intermolecular O—H...O, O—H...Owater and Owater—H...O hydrogen bonds, generating a three-dimensional network. The two potassium cations both show a coordination number of 9.
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31
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Bhaskaran A, Nayyar S, Porta‐Sánchez A, Haldar S, Bokhari M, Massé S, Liang T, Zehra N, Farid T, Downar E, Nanthakumar K. Exit sites on the epicardium rarely subtend critical diastolic path of ischemic VT on the endocardium: Implications for noninvasive ablation. J Cardiovasc Electrophysiol 2019; 30:520-527. [DOI: 10.1111/jce.13843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/04/2018] [Accepted: 12/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Abhishek Bhaskaran
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Sachin Nayyar
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Andreu Porta‐Sánchez
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Shouvik Haldar
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Mahmoud Bokhari
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Stéphane Massé
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Timothy Liang
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Nawazish Zehra
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Talha Farid
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Eugene Downar
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
| | - Kumaraswamy Nanthakumar
- Division of CardiologyPeter Munk Cardiac Centre, Toronto General Hospital, University Health NetworkToronto Ontario Canada
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Nayyar S, Downar E, Beheshti M, Liang T, Massé S, Magtibay K, Bhaskaran A, Saeed Y, Vigmond E, Nanthakumar K. Information theory to tachycardia therapy: electrogram entropy predicts diastolic microstructure of reentrant ventricular tachycardia. Am J Physiol Heart Circ Physiol 2019; 316:H134-H144. [DOI: 10.1152/ajpheart.00581.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There is no known strategy to differentiate which multicomponent electrograms in sinus rhythm maintain reentrant ventricular tachycardia (VT). Low entropy in the voltage breakdown of a multicomponent electrogram can localize conditions suitable for reentry but has not been validated against the classic VT activation mapping. We examined whether low entropy in a late and diversely activated ventricular scar region characterizes and differentiates the diastolic path of VT and represents protected tissue channels devoid of side branches. Intraoperative bipolar electrogram (BiEGM) activation and entropy maps were obtained during sinus rhythm in 17 patients with ischemic cardiomyopathy and compared with diastolic activation paths of VT (total of 39 VTs). Mathematical modeling of a zigzag main channel with side branches was also used to further validate structural representation of low entropy in the ventricular scar. A median of one region per patient (range: 1–2 regions) was identified in sinus rhythm, in which BiEGMwith the latest mean activation time and adjacent minimum entropy were assembled together in a high-activation dispersion region. These regions accurately recognized diastolic paths of 34 VTs, often to multiple inducible VTs within a single individual arrhythmogenic region. In mathematical modeling, side branching from the main channel had a strong influence on the BiEGMcomposition along the main channel. The BiEGMobtained from a long unbranched channel had the lowest entropy compared with those with multiple side branches. In conclusion, among a population of multicomponent sinus electrograms, those that demonstrate low entropy and are delayed colocalize to critical long-protected channels of VT. This information is pertinent for planning VT ablation in sinus rhythm.NEW & NOTEWORTHY Entropy is a measure to quantify breakdown in information. Electrograms from a protected tissue channel can only possess a few states in their voltage and thus less information. In contrast, current-load interactions from side branches in unprotected channels introduce a number of dissimilar voltage deflections and thus high information. We compare here a mapping approach based on entropy against a rigorous reference standard of activation mapping during VT and entropy was assessed in sinus rhythm.
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Affiliation(s)
- Sachin Nayyar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Eugene Downar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Mohammadali Beheshti
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Timothy Liang
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Stéphane Massé
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Karl Magtibay
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Abhishek Bhaskaran
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Yawer Saeed
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
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Nayyar S, Beheshti M, Liang T, Masse S, Bhaskaran A, Downar E, Vigmond E, Nanthakumar K. PREDICTING VENTRICULAR TACHYCARDIA CHANNELS IN HUMANS FROM ENTROPY ANALYSIS OF SINUS RHYTHM ELECTROGRAMS. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.396] [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: 10/28/2022] Open
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Bhaskaran A, Magtibay K, Masse S, Porta-Sanchez A, LaFlamme M, Deno D, Nanthakumar K. DRAG AND MAP STRATEGY FOR DYNAMIC DETECTION OF DISEASED MYOCARDIUM: INNOVATIVE OMNIPOLAR APPLICATION WITH ADVISOR HD GRID. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Farid TA, Bhaskaran A, Nanthakumar K. KATP Channel Blockade as a Novel Antiarrhythmic Strategy: Evolving From Tachy to Brady Therapy. Endocrinology 2018; 159:3081-3082. [PMID: 29955856 DOI: 10.1210/en.2018-00525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 06/18/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Talha A Farid
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
| | - Abhishek Bhaskaran
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
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Qian P, De Silva K, Kumar S, Nadri F, Samanta R, Bhaskaran A, Ross D, Sivagangabalan G, Cooper M, Kizana E, Davis L, Denniss AR, Thiagalingam A, Thomas S, Kovoor P. Early and long-term outcomes after manual and remote magnetic navigation-guided catheter ablation for ventricular tachycardia. Europace 2018; 20:ii11-ii21. [DOI: 10.1093/europace/euy057] [Citation(s) in RCA: 13] [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] [Received: 10/09/2017] [Accepted: 03/12/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Pierre Qian
- Department of Cardiology, Westmead Hospital, Cnr of Hawkesbury and Darcy Rd, Westmead, Sydney, NSW 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kasun De Silva
- Department of Cardiology, Westmead Hospital, Cnr of Hawkesbury and Darcy Rd, Westmead, Sydney, NSW 2145, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Cnr of Hawkesbury and Darcy Rd, Westmead, Sydney, NSW 2145, Australia
| | - Fazlur Nadri
- Department of Cardiology, Westmead Hospital, Cnr of Hawkesbury and Darcy Rd, Westmead, Sydney, NSW 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Rahul Samanta
- Department of Cardiology, Westmead Hospital, Cnr of Hawkesbury and Darcy Rd, Westmead, Sydney, NSW 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Abhishek Bhaskaran
- Department of Cardiology, Westmead Hospital, Cnr of Hawkesbury and Darcy Rd, Westmead, Sydney, NSW 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - David Ross
- Department of Cardiology, Westmead Hospital, Cnr of Hawkesbury and Darcy Rd, Westmead, Sydney, NSW 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Gopal Sivagangabalan
- Department of Cardiology, Westmead Hospital, Cnr of Hawkesbury and Darcy Rd, Westmead, Sydney, NSW 2145, Australia
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
| | - Mark Cooper
- Department of Cardiology, Westmead Hospital, Cnr of Hawkesbury and Darcy Rd, Westmead, Sydney, NSW 2145, Australia
| | - Eddy Kizana
- Department of Cardiology, Westmead Hospital, Cnr of Hawkesbury and Darcy Rd, Westmead, Sydney, NSW 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Lloyd Davis
- Department of Cardiology, Westmead Hospital, Cnr of Hawkesbury and Darcy Rd, Westmead, Sydney, NSW 2145, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Alan Robert Denniss
- Department of Cardiology, Westmead Hospital, Cnr of Hawkesbury and Darcy Rd, Westmead, Sydney, NSW 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Aravinda Thiagalingam
- Department of Cardiology, Westmead Hospital, Cnr of Hawkesbury and Darcy Rd, Westmead, Sydney, NSW 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Stuart Thomas
- Department of Cardiology, Westmead Hospital, Cnr of Hawkesbury and Darcy Rd, Westmead, Sydney, NSW 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Cnr of Hawkesbury and Darcy Rd, Westmead, Sydney, NSW 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
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Porta Sanchez A, Magtibay K, Masse S, Nayyar S, Bhaskaran A, Deno DC, Nanthakumar K. 1019Equi-Spaced Electrode Array for Orientation Independent Bipolar Substrate Mapping. Europace 2018. [DOI: 10.1093/europace/euy015.568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Porta Sanchez
- University Health Network, The Hull Family Cardiac Fibrillation Management Laboratory, Toronto, Canada
| | - K Magtibay
- University Health Network, The Hull Family Cardiac Fibrillation Management Laboratory, Toronto, Canada
| | - S Masse
- University Health Network, The Hull Family Cardiac Fibrillation Management Laboratory, Toronto, Canada
| | - S Nayyar
- University Health Network, The Hull Family Cardiac Fibrillation Management Laboratory, Toronto, Canada
| | - A Bhaskaran
- University Health Network, The Hull Family Cardiac Fibrillation Management Laboratory, Toronto, Canada
| | - D C Deno
- St Jude Medical, Minneapolis, United States of America
| | - K Nanthakumar
- University Health Network, The Hull Family Cardiac Fibrillation Management Laboratory, Toronto, Canada
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Bhaskaran A, Chik W, Pouliopoulos J, Nalliah C, Qian P, Barry T, Nadri F, Samanta R, Tran Y, Thomas S, Kovoor P, Thiagalingam A. Five seconds of 50-60 W radio frequency atrial ablations were transmural and safe: an in vitro mechanistic assessment and force-controlled in vivo validation. Europace 2018; 19:874-880. [PMID: 27207815 DOI: 10.1093/europace/euw077] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/26/2016] [Indexed: 11/13/2022] Open
Abstract
Aims Longer procedural time is associated with complications in radiofrequency atrial fibrillation ablation. We sought to reduce ablation time and thereby potentially reduce complications. The aim was to compare the dimensions and complications of 40 W/30 s setting to that of high-power ablations (50-80 W) for 5 s in the in vitro and in vivo models. Methods and results In vitro ablations-40 W/30 s were compared with 40-80 W powers for 5 s. In vivo ablations-40 W/30 s were compared with 50-80 W powers for 5 s. All in vivo ablations were performed with 10 g contact force and 30 mL/min irrigation rate. Steam pops and depth of lung lesions identified post-mortem were noted as complications. A total of 72 lesions on the non-trabeculated part of right atrium were performed in 10 Ovine. All in vitro ablations except for the 40 W/5 s setting achieved the critical lesion depth of 2 mm. For in vivo ablations, all lesions were transmural, and the lesion depths for the settings of 40 W/30 s, 50 W/5 s, 60 W/5 s, 70 W/5 s, and 80 W/5 s were 2.2 ± 0.5, 2.3 ± 0.5, 2.1 ± 0.4, 2.0 ± 0.3, and 2.3 ± 0.7 mm, respectively. The lesion depths of short-duration ablations were similar to that of the conventional ablation. Steam pops occurred in the ablation settings of 40 W/30 s and 80 W/5 s in 8 and 11% of ablations, respectively. Complications were absent in short-duration ablations of 50 and 60 W. Conclusion High-power, short-duration atrial ablation was as safe and effective as the conventional ablation. Compared with the conventional 40 W/30 s setting, 50 and 60 W ablation for 5 s achieved transmurality and had fewer complications.
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Affiliation(s)
- Abhishek Bhaskaran
- Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - William Chik
- Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jim Pouliopoulos
- Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Chrishan Nalliah
- Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Pierre Qian
- Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Tony Barry
- Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
| | - Fazlur Nadri
- Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Rahul Samanta
- Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Ying Tran
- Biotronik company, Sydney, NSW 2073, Australia
| | - Stuart Thomas
- Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Pramesh Kovoor
- Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Aravinda Thiagalingam
- Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
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Devnikar AV, Beena PM, Bhaskaran A, Shivaprakash MR. Peritonitis due to Galactomyces geotrichum: A Rare Case Report. J Clin Diagn Res 2018. [DOI: 10.7860/jcdr/2018/32124.11140] [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: 11/24/2022]
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Bhaskaran A, Bhatt A, Kizana E, Thomas S, Muthiah K, Kanthan A, Kumar S. Lamin A/C Cardiomyopathy with Refractory Ventricular Tachycardia: A Malignant, Progressive form of Dilated Cardiomyopathy Posing Unique Challenges. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.296] [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: 11/24/2022]
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Bhaskaran A, Kumar S, Kizana E, Thomas S, Chik W. Multi-Modality Imaging, Electrophysiological, Electroanatomical, and Histopathological Characterisation of Atrial Sarcoidosis Presenting with Sinus Node Dysfunction and Sinus Arrest. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.306] [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: 10/28/2022]
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Al Raisi S, Barry M, Qian P, Bhaskaran A, Pouliopoulos J, Kovoor P. Comparison of new-generation renal artery denervation systems: assessing lesion size and thermodynamics using a thermochromic liquid crystal phantom model. EUROINTERVENTION 2017; 13:1242-1247. [DOI: 10.4244/eij-d-17-00278] [Citation(s) in RCA: 6] [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: 11/23/2022]
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Samanta R, Kumar S, Chik W, Qian P, Barry MA, Al Raisi S, Bhaskaran A, Farraha M, Nadri F, Kizana E, Thiagalingam A, Kovoor P, Pouliopoulos J. Influence of Intramyocardial Adipose Tissue on the Accuracy of Endocardial Contact Mapping of the Chronic Myocardial Infarction Substrate. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004998. [PMID: 29038101 DOI: 10.1161/circep.116.004998] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 08/17/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies have demonstrated that intramyocardial adipose tissue (IMAT) may contribute to ventricular electrophysiological remodeling in patients with chronic myocardial infarction. Using an ovine model of myocardial infarction, we aimed to determine the influence of IMAT on scar tissue identification during endocardial contact mapping and optimal voltage-based mapping criteria for defining IMAT dense regions. METHOD AND RESULTS In 7 sheep, left ventricular endocardial and transmural mapping was performed 84 weeks (15-111 weeks) post-myocardial infarction. Spearman rank correlation coefficient was used to assess the relationship between endocardial contact electrogram amplitude and histological composition of myocardium. Receiver operator characteristic curves were used to derive optimal electrogram thresholds for IMAT delineation during endocardial mapping and to describe the use of endocardial mapping for delineation of IMAT dense regions within scar. Endocardial electrogram amplitude correlated significantly with IMAT (unipolar r=-0.48±0.12, P<0.001; bipolar r=-0.45±0.22, P=0.04) but not collagen (unipolar r=-0.36±0.24, P=0.13; bipolar r=-0.43±0.31, P=0.16). IMAT dense regions of myocardium reliably identified using endocardial mapping with thresholds of <3.7 and <0.6 mV, respectively, for unipolar, bipolar, and combined modalities (single modality area under the curve=0.80, P<0.001; combined modality area under the curve=0.84, P<0.001). Unipolar mapping using optimal thresholding remained significantly reliable (area under the curve=0.76, P<0.001) during mapping of IMAT, confined to putative scar border zones (bipolar amplitude, 0.5-1.5 mV). CONCLUSIONS These novel findings enhance our understanding of the confounding influence of IMAT on endocardial scar mapping. Combined bipolar and unipolar voltage mapping using optimal thresholds may be useful for delineating IMAT dense regions of myocardium, in postinfarct cardiomyopathy.
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Affiliation(s)
- Rahul Samanta
- From the Department of Cardiology, Westmead Hospital, New South Wales, Australia (R.S., S.K., W.C., P.Q., M.A.B., S.A.R., A.B., F.N., E.K., A.T., P.K., J.P.); and Sydney Medical School, University of Sydney, Australia (R.S., W.C., S.A.R., A.B., M.F., E.K., A.T., P.K., J.P.)
| | - Saurabh Kumar
- From the Department of Cardiology, Westmead Hospital, New South Wales, Australia (R.S., S.K., W.C., P.Q., M.A.B., S.A.R., A.B., F.N., E.K., A.T., P.K., J.P.); and Sydney Medical School, University of Sydney, Australia (R.S., W.C., S.A.R., A.B., M.F., E.K., A.T., P.K., J.P.)
| | - William Chik
- From the Department of Cardiology, Westmead Hospital, New South Wales, Australia (R.S., S.K., W.C., P.Q., M.A.B., S.A.R., A.B., F.N., E.K., A.T., P.K., J.P.); and Sydney Medical School, University of Sydney, Australia (R.S., W.C., S.A.R., A.B., M.F., E.K., A.T., P.K., J.P.)
| | - Pierre Qian
- From the Department of Cardiology, Westmead Hospital, New South Wales, Australia (R.S., S.K., W.C., P.Q., M.A.B., S.A.R., A.B., F.N., E.K., A.T., P.K., J.P.); and Sydney Medical School, University of Sydney, Australia (R.S., W.C., S.A.R., A.B., M.F., E.K., A.T., P.K., J.P.)
| | - Michael A Barry
- From the Department of Cardiology, Westmead Hospital, New South Wales, Australia (R.S., S.K., W.C., P.Q., M.A.B., S.A.R., A.B., F.N., E.K., A.T., P.K., J.P.); and Sydney Medical School, University of Sydney, Australia (R.S., W.C., S.A.R., A.B., M.F., E.K., A.T., P.K., J.P.)
| | - Sara Al Raisi
- From the Department of Cardiology, Westmead Hospital, New South Wales, Australia (R.S., S.K., W.C., P.Q., M.A.B., S.A.R., A.B., F.N., E.K., A.T., P.K., J.P.); and Sydney Medical School, University of Sydney, Australia (R.S., W.C., S.A.R., A.B., M.F., E.K., A.T., P.K., J.P.)
| | - Abhishek Bhaskaran
- From the Department of Cardiology, Westmead Hospital, New South Wales, Australia (R.S., S.K., W.C., P.Q., M.A.B., S.A.R., A.B., F.N., E.K., A.T., P.K., J.P.); and Sydney Medical School, University of Sydney, Australia (R.S., W.C., S.A.R., A.B., M.F., E.K., A.T., P.K., J.P.)
| | - Melad Farraha
- From the Department of Cardiology, Westmead Hospital, New South Wales, Australia (R.S., S.K., W.C., P.Q., M.A.B., S.A.R., A.B., F.N., E.K., A.T., P.K., J.P.); and Sydney Medical School, University of Sydney, Australia (R.S., W.C., S.A.R., A.B., M.F., E.K., A.T., P.K., J.P.)
| | - Fazlur Nadri
- From the Department of Cardiology, Westmead Hospital, New South Wales, Australia (R.S., S.K., W.C., P.Q., M.A.B., S.A.R., A.B., F.N., E.K., A.T., P.K., J.P.); and Sydney Medical School, University of Sydney, Australia (R.S., W.C., S.A.R., A.B., M.F., E.K., A.T., P.K., J.P.)
| | - Eddy Kizana
- From the Department of Cardiology, Westmead Hospital, New South Wales, Australia (R.S., S.K., W.C., P.Q., M.A.B., S.A.R., A.B., F.N., E.K., A.T., P.K., J.P.); and Sydney Medical School, University of Sydney, Australia (R.S., W.C., S.A.R., A.B., M.F., E.K., A.T., P.K., J.P.)
| | - Aravinda Thiagalingam
- From the Department of Cardiology, Westmead Hospital, New South Wales, Australia (R.S., S.K., W.C., P.Q., M.A.B., S.A.R., A.B., F.N., E.K., A.T., P.K., J.P.); and Sydney Medical School, University of Sydney, Australia (R.S., W.C., S.A.R., A.B., M.F., E.K., A.T., P.K., J.P.)
| | - Pramesh Kovoor
- From the Department of Cardiology, Westmead Hospital, New South Wales, Australia (R.S., S.K., W.C., P.Q., M.A.B., S.A.R., A.B., F.N., E.K., A.T., P.K., J.P.); and Sydney Medical School, University of Sydney, Australia (R.S., W.C., S.A.R., A.B., M.F., E.K., A.T., P.K., J.P.)
| | - Jim Pouliopoulos
- From the Department of Cardiology, Westmead Hospital, New South Wales, Australia (R.S., S.K., W.C., P.Q., M.A.B., S.A.R., A.B., F.N., E.K., A.T., P.K., J.P.); and Sydney Medical School, University of Sydney, Australia (R.S., W.C., S.A.R., A.B., M.F., E.K., A.T., P.K., J.P.).
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Bhimji A, Bhaskaran A, Singer LG, Kumar D, Humar A, Pavan R, Lipton J, Kuruvilla J, Schuh A, Yee K, Minden MD, Schimmer A, Rotstein C, Keshavjee S, Mazzulli T, Husain S. Aspergillus galactomannan detection in exhaled breath condensate compared to bronchoalveolar lavage fluid for the diagnosis of invasive aspergillosis in immunocompromised patients. Clin Microbiol Infect 2017; 24:640-645. [PMID: 28970160 DOI: 10.1016/j.cmi.2017.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Exhaled breath condensate (EBC) is a noninvasive means of sampling the airways that has shown significant promise in the diagnosis of many disorders. There have been no reports of its usefulness in the detection of galactomannan (GM), a component of the cell wall of Aspergillus. The suitability of EBC for the detection of GM for the diagnosis of invasive aspergillosis (IA) using the Platelia Aspergillus enzyme-linked immunosorbent assay was investigated. METHODS Prospective, cross-sectional study of lung transplant recipient and haemotologic malignancy patients at a university centre. EBC samples were compared to concomitant bronchoalveolar lavage (BAL) samples among lung transplant recipients and healthy controls. EBC was collected over 10 minutes using a refrigerated condenser according to the European Respiratory Society/American Thoracic Society recommendations, with the BAL performed immediately thereafter. RESULTS A total of 476 EBC specimens with 444 matched BAL specimens collected from lung transplant recipients (n = 197) or haemotologic malignancy patients (n = 133) were examined. Both diluted and untreated EBC optical density (OD) values (0.0830, interquartile range (IQR) 0.0680-0.1040; and 0.1130, IQR 0.0940-0.1383), respectively, from all patients regardless of clinical syndrome were significantly higher than OD values in healthy control EBCs (0.0508, IQR 0.0597-0.0652; p < 0.0001). However, the OD index values did not correlate with the diagnosis of IA (44 samples were associated with IA). Furthermore, no significant correlation was found between EBC GM and the matched BAL specimen. CONCLUSIONS GM is detectable in EBC; however, no correlation between OD index values and IA was noted in lung transplant recipients.
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Affiliation(s)
- A Bhimji
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - A Bhaskaran
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - L G Singer
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - D Kumar
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - A Humar
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - R Pavan
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - J Lipton
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - J Kuruvilla
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - A Schuh
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - K Yee
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - M D Minden
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - A Schimmer
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - C Rotstein
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - S Keshavjee
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - T Mazzulli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - S Husain
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada.
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Bhimji A, Bhaskaran A, Singer L, Kumar D, Humar A, Pavan R, Rotstein C, Keshavjee S, Mazzulli T, Husain S. Aspergillus Galactomannan Detection in Exhaled Breath Condensate for the Diagnosis of Invasive Aspergillosis in Lung Transplant Recipients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.051] [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: 11/25/2022] Open
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Bhaskaran A, Albarri M, Ross N, Al Raisi S, Samanta R, Roode L, Nadri F, Ng J, Thomas S, Thiagalingam A, Kovoor P. Slow Pathway Radiofrequency Ablation Using Magnetic Navigation: A Description of Technique and Retrospective Case Analysis. Heart Lung Circ 2017; 26:1297-1302. [PMID: 28318819 DOI: 10.1016/j.hlc.2017.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 12/18/2016] [Accepted: 01/15/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Magnetic Navigation System (MNS) catheter was shown to be stable in the presence of significant cardiac wall motion and delivered more effective lesions compared to manual control. This stability could potentially make AV junctional re-entrant tachycardia (AVNRT) ablation safer. The aim of this study is to describe the method of mapping and ablation of AVNRT with MNS and 3-D electro-anatomical mapping system (CARTO, Biosense Webster, Diamond bar, CA, USA) anatomical mapping, with a view to improve the safety of ablation. METHODS The method of precise mapping and ablation with MNS is described. Consecutive AVNRT cases (n=30) from 2012 January to 2015 November, in which magnetic navigation was used, are analysed. RESULTS Ablation was successful in 27 (90%) out of 30 patients. In three cases, ablation was abandoned due to the proximity of the three-dimensional His image to the potential ablation site. No complications, including AV nodal injury, occurred. The distance from the nearest His position to successful ablation site in both LAO and RAO projections of CARTO images was 26.4±8.8 and 27±7.7mm respectively. Only in two (9%) patients, ablation needed to be extended superior to the plane of coronary sinus ostium, towards the His bundle region, to achieve slow pathway modification. CONCLUSION AVNRT ablation with MNS allows for accurate mapping of the AV node and stable ablation at a safe distance, which could help avoid AV nodal injury. We recommend this modality for younger patients with AVNRT.
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Affiliation(s)
- Abhishek Bhaskaran
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Maha Albarri
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Neil Ross
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - Sara Al Raisi
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Rahul Samanta
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | | | - Fazlur Nadri
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jeanette Ng
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Stuart Thomas
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Aravinda Thiagalingam
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Pramesh Kovoor
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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Qian P, Barry M, Al-Raisi S, Kovoor P, Pouliopoulos J, Nalliah C, Bhaskaran A, Chik W, Kurup R, James V, Varikatt W, McEwan A, Thiagalingam A, Thomas S. Transcatheter non-contact microwave ablation may enable circumferential renal artery denervation while sparing the vessel intima and media. EUROINTERVENTION 2017; 12:e1907-e1915. [DOI: 10.4244/eij-d-16-00509] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Qian P, Da Silva K, Kumar S, Kurup R, Nadri F, Samanta R, Bhaskaran A, Ross D, Sivagangabalan G, Cooper M, Davis L, Denniss R, Thiagalingam A, Thomas S, Kovoor P. Early and Long-Term Outcomes After Manual and Remote Magnetic Navigation Guided Ventricular Tachycardia Ablation. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.311] [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: 10/19/2022]
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Samanta R, Kumar S, Chik W, Bhaskaran A, Farraha M, Qian P, Nadri F, Kizana E, Raisi SA, Thiagalingam A, Kovoor P, Pouliopoulos J. The Use of Unipolar Endocardial Contact Mapping to Detect the Presence of Intramyocardial Adipose Tissue in the Chronic Myocardial Infarction Substrate. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.300] [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: 11/16/2022]
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Bhaskaran A, Nalliah C, Chik W, Pouliopoulos J, Ng J, Barry MA, Nadri F, Raisi SA, Dandach J, Thomas S, Kovoor P, Thiagalingam A. Ninety Seconds Could be the Optimal Duration for Ventricular Radiofrequency Ablation - Results From a Myocardial Phantom Model. Heart Lung Circ 2016; 26:219-225. [PMID: 27449903 DOI: 10.1016/j.hlc.2016.05.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 12/29/2015] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Shallow lesions could be the predominant factor affecting the efficacy of ventricular radiofrequency (RF) ablations. The objective of this study was to assess lesion dimensions and overheating in extended RF ablations up to 180seconds and compare with that of conventional 30seconds ablations. METHODS The Navistar Thermocool irrigated catheter (Biosense Webster, CA, USA) was used in a previously validated myocardial phantom. Ablations were performed with 20W, 30W, 40W and 50W powers for 180seconds. The volume of lesion and overheating were measured at 530C and 800C isotherms respectively. RESULTS A total of 110 RF lesions were analysed. The lesion depth increment when ablation was extended from the conventional 30seconds to 90seconds were 31.2±0.2, 33.6±0.6, 36.3±1.8% of that at 30seconds, respectively for powers 30W, 40W and 50W. During 30W ablations, at 90seconds the lesion width and depth were 95.4±1.2%, 91.8±1.6% respectively of the final dimensions at 180seconds. Similar proportions were observed for 40W and 50W. During 40W ablations, the volume of overheating was 113±6% and 184±11% higher at 90seconds and 180seconds respectively compared to that at 30seconds and was 142±9% and 194±9% for 50W ablations. CONCLUSION Extending RF ablations up to 90seconds significantly increased the lesion depth (30-40%), however, overheating was present at 40W and 50W powers. Ablations beyond 90seconds provided little incremental value.
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Affiliation(s)
- Abhishek Bhaskaran
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Chrishan Nalliah
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; School of Electrical and Information Engineering, University of Sydney, Sydney, NSW, Australia
| | - William Chik
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jim Pouliopoulos
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jeanette Ng
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - M A Barry
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Fazlur Nadri
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Sara Al Raisi
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Juliana Dandach
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Stuart Thomas
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Pramesh Kovoor
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Aravinda Thiagalingam
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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