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Vijayaraman P, Trivedi RS, Koneru JN, Sharma PS, De Pooter J, Schaller RD, Cano Ó, Whinnett ZI, Migliore F, Ponnusamy SS, Skeete JR, Zanon F, Heuverswyn FV, Kolominsky J, Pittorru R, Mumtaz M, Ellenbogen KA, Herweg B. Transvenous extraction of conduction system pacing leads: An international multicenter (TECSPAM) study. Heart Rhythm 2024:S1547-5271(24)02381-6. [PMID: 38762819 DOI: 10.1016/j.hrthm.2024.04.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Conduction system pacing (CSP) by His bundle pacing or left bundle branch area pacing (LBBAP) is incorporated into Heart Rhythm Society guidelines for the management of bradycardia and cardiac resynchronization therapy. Despite increasing adoption with both lumenless leads and stylet-driven leads, concerns regarding the feasibility and safety of the extraction of CSP leads remain. OBJECTIVE The aim of the study was to report on the safety, feasibility, and clinical outcomes of the extraction of CSP leads. METHODS Patients undergoing the extraction of CSP leads from 10 international centers were enrolled in this retrospective study. Data regarding indications, lead location, lead type, extraction tools, procedural success, complications, and reimplantation in the conduction system were collected. RESULTS Overall, 341 patients (age 69 ± 15 years; female 117 (34%); cardiomyopathy 157 (46%); lead dwell time 22 ± 26 months) underwent the extraction of 224 His bundle pacing and 117 LBBAP leads (lumenless leads 321; stylet-driven leads 20). Complete procedural success was achieved in 338 (99%), while clinical success was 100% with retained distal fragments in 3 patients (1%). Among patients with a lead dwell time of >6 months (6-193 months; n = 226), manual extraction was successful in 198 (87%), mechanical tools in 22 (10%), and laser in 6 (3%). Femoral tools were necessary in 3 patients. Minor complications occurred in 7 patients (2.1%). Reimplantation in the conduction system was successful in 233 of 244 patients attempted (95%). CONCLUSION The overall success rates of the extraction of CSP leads were very high (although the LBBAP lead dwell time was <3 years), with a low need for extraction tools and minimal complication. Reimplantation in the conduction system is feasible and safe.
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Affiliation(s)
| | | | | | | | | | - Robert D Schaller
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Óscar Cano
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Federico Migliore
- Department of Cardiac, Thoracic Vascular Sciences and Public Health University of Padova, Padova, Italy
| | | | | | | | | | | | - Raimondo Pittorru
- Department of Cardiac, Thoracic Vascular Sciences and Public Health University of Padova, Padova, Italy
| | - Mishal Mumtaz
- University of South Florida Morsani College of Medicine, Tampa, Florida
| | | | - Bengt Herweg
- University of South Florida Morsani College of Medicine, Tampa, Florida
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Raymond-Paquin A, Pillai A, Myadam R, Mankad P, Lovejoy S, Koneru JN, Ellenbogen KA. Atypical atrial flutter catheter ablation in the era of high-density mapping. J Interv Card Electrophysiol 2023; 66:1807-1815. [PMID: 36645578 DOI: 10.1007/s10840-023-01475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/10/2023] [Indexed: 01/17/2023]
Abstract
BACKGROUND Mapping and ablating atypical atrial flutters (AAFLs) have evolved greatly with advances in high-density 3D mapping systems over the last years. METHODS The objectives are to evaluate the feasibility of AAFL catheter ablation based on high-density mapping and minimizing entrainment and to better characterize AAFL circuits. Consecutive patients who underwent AAFL ablation using the EnSite Precision™ system and HD Grid™ mapping catheter (Abbott, Chicago, IL) between 06/2018 and 1/2022 were included. Mitral isthmus-dependent and roof-dependent AAFLs were classified as conventional circuits. All other AAFL circuits were classified as non-conventional circuits and were defined based on the location of the critical isthmus. RESULTS Sixty-two patients underwent AAFL ablation (mean age 68±11 years). A total of 95 AAFLs were mapped and 92 (97%) were successfully ablated. Fifty-three (85%) patients had a previous AF/AFL ablation. Forty-four (46%) AAFL circuits were classified as conventional and 51 (54%) as non-conventional. Conventional AAFL circuits had longer critical isthmuses (19.0±9.0 vs 10.8±6.3mm, p<0.001), a lower prevalence of slow conduction at the critical isthmus (59% vs 86%, p=0.005), and a longer radiofrequency time to AAFL termination (117±119 vs 51±66 s, p=0.002). Entrainment was attempted in 19 (20%) flutters and its use declined significantly over the study period. Procedural success rates remained high whether entrainment was used or not. Freedom of any atrial tachycardia was 65% over a follow-up of 13.8±9.0 months. CONCLUSIONS AAFL catheter ablation can be achieved with high procedural success rate using a contemporary strategy based on high-density mapping alone. Non-conventional circuits are frequent and present unique electrophysiological characteristics.
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Affiliation(s)
- Alexandre Raymond-Paquin
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000, Bélanger Street, Montreal, Quebec, H1T 1C8, Canada.
| | - Ajay Pillai
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Rahul Myadam
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Pranav Mankad
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Jayanthi N Koneru
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
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Koneru JN, Ellenbogen KA. When the Trigger Becomes the Target: Zeroing-In on Nonpulmonary Vein Triggers of Atrial Fibrillation. JACC Clin Electrophysiol 2023; 9:2288-2290. [PMID: 37831034 DOI: 10.1016/j.jacep.2023.08.028] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Jayanthi N Koneru
- Cardiology Division, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Kenneth A Ellenbogen
- Cardiology Division, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
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Koneru JN, Ellenbogen KA. Advanced imaging integration: A miter saw that cuts the complexity of papillary muscle premature ventricular contractions. Heart Rhythm 2023; 20:1455-1456. [PMID: 37451497 DOI: 10.1016/j.hrthm.2023.07.006] [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: 06/30/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
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Koneru JN, Ellenbogen KA. First Among Equals?: Is Left Bundle Branch Pacing Superior to Biventricular Pacing for Heart Failure? JACC Clin Electrophysiol 2023; 9:1582-1584. [PMID: 37227341 DOI: 10.1016/j.jacep.2023.05.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/26/2023]
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Mitchell B, Patel NK, Koneru JN. TAKOTSUBO CARDIOMYOPATHY IN A RECENTLY TRANSPLANTED HEART. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03962-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Pillai A, Robila V, Kasirajan V, Ellenbogen KA, Koneru JN. Ex-vivo histopathologic examination of irrigated radiofrequency ablation utilizing half-normal saline of the human heart. J Cardiovasc Electrophysiol 2023; 34:900-907. [PMID: 36738139 DOI: 10.1111/jce.15840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/07/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) utilizing half-normal saline (HNS) irrigation is a promising intervention to circumvent commonly encountered limitations during radiofrequency ablation of deep myocardial substrate. Few studies to date have analyzed the morphologic changes in the human myocardium following HNS RFA. METHODS AND RESULTS Three patients with symptomatic ventricular tachycardia (VT) who underwent RFA with HNS irrigation underwent pathological specimen examination at time of autopsy or following native heart explant at the time of cardiac transplantation. Gross evaluation of the heart was performed fresh and after fixation in 10% formalin. A routine examination was performed with fixation in 10% formalin. Sections of lesioned tissue were paraffin embedded and evaluated using standard hematoxylin and eosin (H&E) staining. CONCLUSION Irrigated RF ablation with HNS irrigant produces coagulative necrosis as well as several delayed histopathological changes with a deeper field of effective ablation. Transmurality may not be obtained in the ventricular myocardium with endocardial, epicardial, or sequential unipolar HNS ablation.
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Affiliation(s)
- Ajay Pillai
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Valentina Robila
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Vigneshwar Kasirajan
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jayanthi N Koneru
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
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Koneru JN. Ablating Persistent Atrial Fibrillation - Still Learning While Burning! NEJM Evid 2022; 1:EVIDe2200246. [PMID: 38319858 DOI: 10.1056/evide2200246] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Pulmonary vein isolation (PVI) remains the cornerstone of atrial fibrillation (AF) ablation for both paroxysmal and persistent AF; however, the rates of freedom from arrhythmia observed after PVI for persistent AF are markedly lower compared with the rates observed for paroxysmal AF.1-3 Inexorable atrial structural and electrical remodeling in AF leads to an arrhythmogenic substrate that favors the genesis and perpetuation of persistent AF. The pathogenesis of paroxysmal AF differs from that of persistent AF.
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Affiliation(s)
- Jayanthi N Koneru
- Pauley Heart Center, Section of Cardiac Electrophysiology, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, VA
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Koneru JN, Ellenbogen KA. Reply to the Editor- The Anatomical Correlations to the Atrioventricular Node. Heart Rhythm 2022; 19:1397-1398. [PMID: 35580825 DOI: 10.1016/j.hrthm.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Jayanthi N Koneru
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia.
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Raymond-Paquin A, Verma A, Kolominsky J, Sanchez-Somonte P, Gul E, Pillai A, Kron J, Shepard R, Kalahasty G, Tsang B, Khaykin Y, Pantano A, Koneru JN, Ellenbogen KA. Left Bundle Branch Area Pacing in Patients with Atrioventricular Conduction Disease: A Prospective Multicenter Study. Heart Rhythm 2022; 19:1484-1490. [PMID: 35562056 DOI: 10.1016/j.hrthm.2022.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/22/2022] [Accepted: 04/10/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The reported success rate of His bundle pacing (HBP) in patients with infranodal atrioventricular (AV) conduction disease is only 52-76%. The success rate of left bundle branch area pacing (LBBAP) in this cohort is not well studied. OBJECTIVE To evaluate the feasibility, safety, and electrophysiological characteristics of LBBAP in patients with AV conduction disease. METHODS Patients with AV conduction disease referred for pacemaker implantation at two centers between 02/2019 and 6/2021 were considered for LBBAP. Baseline demographic characteristics, procedural success rates, electrophysiological parameters and complications were assessed. RESULTS LBBAP was successful in 340/364 (93%) patients. Mean age was 72±13 years and mean follow-up was 331±244 days. Pacing indications were Mobitz I in 27 patients (7%), Mobitz II or 2:1 AV block or high-grade AV block in 94 patients (26%), complete heart block in 199 patients (55%) and sick sinus syndrome with isolated bundle branch block in 44 patients (12%). LBBB and RBBB were present in 57 patients (16%) and 140 patients (38%) respectively. Procedural success rates did not differ between indications (92.6%, 93.6%, 92.9% and 95% respectively) or between patients with narrow (<120ms) versus wide QRS (≥120ms). Mean LBBAP threshold was 0.77±0.34V at 0.4ms at implant and remained stable during follow-up. There were 4 (1.2%) acute LBBAP lead dislodgements. CONCLUSIONS LBBAP is safe and feasible with high success rates for patients with AV conduction disease. Contrary to HBP, LBBAP success rates remain high over the entire spectrum of AV conduction disease and lead parameters remain stable during follow-up.
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Affiliation(s)
- Alexandre Raymond-Paquin
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA; Montreal Heart Institute, Department of Medicine, Université de Montréal, Québec, Canada.
| | - Atul Verma
- Division of Cardiology, Southlake Regional Health Center, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Kolominsky
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paula Sanchez-Somonte
- Division of Cardiology, Southlake Regional Health Center, University of Toronto, Toronto, Ontario, Canada
| | - Elvin Gul
- Division of Cardiology, Southlake Regional Health Center, University of Toronto, Toronto, Ontario, Canada
| | - Ajay Pillai
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jordana Kron
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Richard Shepard
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Gautham Kalahasty
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Bernice Tsang
- Division of Cardiology, Southlake Regional Health Center, University of Toronto, Toronto, Ontario, Canada
| | - Yaariv Khaykin
- Division of Cardiology, Southlake Regional Health Center, University of Toronto, Toronto, Ontario, Canada
| | - Alfredo Pantano
- Division of Cardiology, Southlake Regional Health Center, University of Toronto, Toronto, Ontario, Canada
| | - Jayanthi N Koneru
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kenneth A Ellenbogen
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
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Kolominsky J, Pillai A, Teigeler TL, Raymond-Paquin A, Shepard RK, Kalahasty G, Kron J, Koneru JN, Ellenbogen KA, Padala SK. PO-708-06 FEASIBILITY OF RIGHT SIDED LEFT BUNDLE BRANCH AREA PACEMAKER INSERTION: A SINGLE CENTER PROSPECTIVE STUDY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Raymond-Paquin A, Myadam R, Lovejoy SJ, Koneru JN, Ellenbogen KA, Padala SK. PO-667-05 CATHETER ABLATION OF ATYPICAL ATRIAL FLUTTER IN THE ERA OF HIGH-DENSITY MAPPING: IS ENTRAINMENT STILL MANDATORY? Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pillai A, Kolominsky J, Koneru JN, Kron J, Shepard RK, Kalahasty G, Huang W, Verma A, Ellenbogen KA. Atrioventricular Junction Ablation in Patients with the Conduction System Pacing Leads: A Comparison of His Bundle vs Left Bundle Branch Area Pacing Leads. Heart Rhythm 2022; 19:1116-1123. [DOI: 10.1016/j.hrthm.2022.03.1222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
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Damonte JI, Del Buono MG, Li P, Kapoor K, Mao Y, Ravindra K, Westman PC, Chiabrando JG, Oakes T, Rodriguez-Miguelez P, Gal T, Padala SK, Koneru JN, Ellenbogen KA, Kron J, Abbate A. QT PROLONGATION AND IN-HOSPITAL VENTRICULAR ARRHYTHMIC COMPLICATIONS IN PATIENTS ADMITTED WITH APICAL BALLOONING TAKOTSUBO SYNDROME. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01006-3] [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: 10/18/2022]
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Larsen TR, Shepard RK, Koneru JN, Cabrera JA, Ellenbogen KA, Padala SK. Electrocardiographic characteristics and ablation of ventricular arrhythmias originating from the basal inferoseptal area. Europace 2021; 23:1970-1979. [PMID: 34472607 DOI: 10.1093/europace/euab189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 07/12/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Ventricular arrhythmias (VAs) from the basal inferoseptal (BIS) area are rare and can pose unique challenges during catheter ablation (CA) due to the anatomic complexity. The study sought to describe the electrocardiographic and clinical characteristics of VAs originating from the BIS area. METHODS AND RESULTS Patients with VAs and successful ablation at the BIS area from 2016 to 2020 were included. The 12-lead electrocardiogram (ECG), intracardiac findings, and outcomes were analysed. Of 482 patients with VAs referred for CA, 17 (3.5%) had successful ablation at BIS area. There were 12 males, mean age was 66.7 ± 9 years, 82% had ejection fraction <50%. Mean baseline premature ventricular complex burden was 28.6 ± 9%. All patients had a leftward superior axis. Left bundle branch block (LBBB) with early transition in V2 was noted in eight patients and right bundle branch block (RBBB) in nine patients. Detailed mapping of the right ventricle (RV) was performed in 15 patients (88%), coronary sinus (CS)/middle cardiac vein (MCV) in 13 (76%), right atrium (RA) adjacent to the inferoseptal process (ISP) of left ventricle (LV) in 5 (29%), ISP-LV in 13 (76%), and epicardium in 2 (12%). Successful ablation site was in LV in 10 (59%), RV in 2 (12%), CS/MCV in 1 (6%), RA in 1 (6%), and epicardium in 2 (12%). Fifteen patients (88%) required mapping in at least two chambers (range 2-5) and seven patients (41%) required ablation in at least two chambers (range 2-3). CONCLUSIONS Ventricular arrhythmias originating in the BIS are uncommon. The most common ECG patterns were leftward superior axis, LBBB with transition in V2 or RBBB. The VA foci can be endocardial or epicardial and meticulous mapping/ablation from multiple chambers is often required to eliminate these foci successfully.
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Affiliation(s)
- Timothy R Larsen
- Department of Medicine, Division of Cardiology, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, USA
| | - Richard K Shepard
- Department of Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Gateway Bldg, 3rd Floor, 3-216, 1200 East Marshall St, Richmond, VA 23298, USA
| | - Jayanthi N Koneru
- Department of Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Gateway Bldg, 3rd Floor, 3-216, 1200 East Marshall St, Richmond, VA 23298, USA
| | - José-Angel Cabrera
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirón-Salud Madrid, Calle Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Kenneth A Ellenbogen
- Department of Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Gateway Bldg, 3rd Floor, 3-216, 1200 East Marshall St, Richmond, VA 23298, USA
| | - Santosh K Padala
- Department of Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Gateway Bldg, 3rd Floor, 3-216, 1200 East Marshall St, Richmond, VA 23298, USA
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Pillai A, Koneru JN, Ellenbogen KA, Padala SK. Autonomic Modulation for Treatment of Repolarization Alternans and Refractory Ventricular Electrical Storm. JACC Case Rep 2021; 3:1438-1443. [PMID: 34557688 PMCID: PMC8446025 DOI: 10.1016/j.jaccas.2021.06.040] [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] [Received: 03/23/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
Macroscopic T-wave alternans (TWA) is a rare finding on surface electrocardiogram and has been associated with an increased risk of impending sudden cardiac death. We highlight a case of macroscopic TWA in a patient with markedly prolonged QTc interval preceding ventricular electrical storm, which was refractory to medical management. Autonomic modulation of the stellate ganglion resulted in improvement in both TWA and QTc interval. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Ajay Pillai
- Address for correspondence: Dr Ajay Pillai, Division of Cardiac Electrophysiology, Virginia Commonwealth University, Gateway Building, 3rd Floor, 3-216, 1200 East Marshall Street, Richmond, Virginia 23298, USA. @AjayPMD
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Padala SK, Kolominsky J, Gul EE, Pillai A, Sanchez Somonte P, Kron J, Shepard RK, Kalahasty G, Tsang B, Khaykin Y, Pantano AA, Koneru JN, Ellenbogen KA, Verma A. B-AB14-02 INTERMEDIATE TERM PERFORMANCE AND SAFETY OF LEFT BUNDLE BRANCH AREA CONDUCTION SYSTEM PACING LEADS: A MULTICENTER PROSPECTIVE STUDY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.083] [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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Pillai A, Kolominsky J, Kron J, Shepard RK, Kalahasty G, Koneru JN, Verma A, Ellenbogen KA, Padala SK. B-PO03-044 SAFETY AND FEASIBILITY OF LEFT POSTERIOR FASCICULAR PACING: A PROSPECTIVE SINGLE CENTER STUDY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.520] [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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Pillai A, Kolominsky J, Kron J, Shepard RK, Kalahasty G, Koneru JN, Verma A, Ellenbogen KA, Padala SK. B-PO05-037 ELECTROCARDIOGRAPHIC CHARACTERISTICS WITH LEFT BUNDLE BRANCH AREA PACING: A SINGLE CENTER PROSPECTIVE STUDY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.957] [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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Gul EE, Kabadi RA, Padala SK, Sanchez Somonte P, Kron J, Shepard RK, Koneru JN, Kalahasty G, Terricabras M, Tsang B, Khaykin Y, Wulffhart Z, Pantano A, Ellenbogen KA, Verma A. Safety and feasibility of left bundle branch area pacing following valvular interventions: Multicenter study. J Cardiovasc Electrophysiol 2021; 32:2515-2521. [PMID: 34245466 DOI: 10.1111/jce.15153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/27/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate the safety and feasibility of left bundle branch area pacing (LBBAP) in patients with valvular interventions. METHODS Eighty-four patients were included in this study. All patients underwent recent surgical or percutaneous valvular interventions. LBBAP was attempted in all patients. Implant success rates, peri- and postprocedure electrocardiogram, pacing parameters, and complications were assessed at implant, and during follow-up. RESULTS LBBAP implantation was successful in 80/84 (95%) patients. Mean age was 74.1 ± 13.8 years and 56% patients were male. Prior valvular replacements included: percutaneous aortic (26), surgical aortic (36), combined surgical aortic plus mitral (6), MVR (10), tricuspid (1), and pulmonic (1). Average LVEF was 52.6 ± 11%. Majority of patients underwent LBBAP due to atrioventricular block (76%) and sinus node disease (13%). Total procedure duration was 74.1 ± 12.5 min and fluoroscopic duration was 9.7 ± 6.8 min. Pacing parameters were stable during follow-up period of 10.0 ± 6.3 months. Pacing QRS duration was significantly narrower than baseline QRS duration (131.5 ± 31.4 ms vs. 114.3 ± 13.7 ms, p < .001, respectively). No acute complications were observed. Mean follow-up was 10.0 ± 6.3 months (median: 8.4 months, min: 1 and max: 24 months). During follow-up, there were three device infections and two patients had loss of LBBA capture within 1 month of implant. CONCLUSIONS LBBAP is a feasible and safe pacing modality in patients with prior interventions for valvular heart disease.
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Affiliation(s)
- Enes Elvin Gul
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rajiv A Kabadi
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Santosh K Padala
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paula Sanchez Somonte
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jordana Kron
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Richard K Shepard
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jayanthi N Koneru
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Gautham Kalahasty
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Maria Terricabras
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Bernice Tsang
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yaariv Khaykin
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Zaev Wulffhart
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alfredo Pantano
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth A Ellenbogen
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Atul Verma
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
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21
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Kowlgi GN, Ramirez RJ, Kaszala K, Joslyn M, Koneru JN, Ellenbogen KA, Tan AY, Huizar JF. Post-extrasystolic potentiation as a predictor of premature ventricular contraction-cardiomyopathy in an animal model. Europace 2021; 22:813-820. [PMID: 32142121 DOI: 10.1093/europace/euaa025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/21/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS High premature ventricular contractions (PVCs) burden does not always predict the development of PVC-cardiomyopathy (CM). We sought to evaluate post-extrasystolic potentiation (PESP) of left ventricular ejection fraction (LVEF) to predict the severity of PVC-CM in an animal model. METHODS AND RESULTS Right ventricular apical bigeminal PVCs were introduced for 12 weeks in 11 canines to induce PVC-CM. Echocardiograms were performed to obtain LVEF without ectopy (Echo-1) and during PVCs (200 and 350 ms coupling intervals, Echo-2, and Echo-3, respectively), and premature atrial contractions (PACs) (Echo-4) at baseline and after 12 weeks of bigeminal PVCs. PESP was calculated as delta-LVEF between the sinus beat post-ectopy LVEF (Echo-2, -3, and -4, respectively) and LVEF without PVC (Echo-1) at baseline and 12 weeks of high PVC burden. A hyperdynamic LV function (LVEF > 70%) was noted in all animals only with early-coupled PVCs (LVEF at 200 ms: 74.4 ± 6%) at baseline. While PVC PESP at 200 ms had a strong significant correlation with the final 12-week LVEF (R = 0.8, P = 0.003), PVC PESP at 350 ms and PAC PESP had a positive but non-significant correlation (R = 0.53, P = 0.09, and R = 0.29, P = 0.34, respectively). Premature ventricular contraction PESP at 350 ms was significantly higher after PVC-CM had developed (delta-LVEF baseline 2.7 ± 2.9% vs. 12 weeks 18.6 ± 12.3% P < 0.001). CONCLUSION Bigeminal early-coupled PVCs cause hyperdynamic left ventricular function in the structurally normal canine heart due to PESP. The degree of PESP at baseline is inversely proportional to the PVC-CM severity at 12 weeks and maybe a predictor of PVC-CM as it may assess the myocardial adaptation reserve to PVCs.
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Affiliation(s)
- Gurukripa N Kowlgi
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Ste. 4A-100, Richmond, VA 23249, USA
| | - Rafael J Ramirez
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Ste. 4A-100, Richmond, VA 23249, USA
| | - Karoly Kaszala
- Hunter Holmes McGuire Veterans Affairs Medical Center, 1201 Broad Rock Blvd, Richmond, VA, USA
| | - Martha Joslyn
- Hunter Holmes McGuire Veterans Affairs Medical Center, 1201 Broad Rock Blvd, Richmond, VA, USA
| | - Jayanthi N Koneru
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Ste. 4A-100, Richmond, VA 23249, USA
| | - Kenneth A Ellenbogen
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Ste. 4A-100, Richmond, VA 23249, USA
| | - Alex Y Tan
- Hunter Holmes McGuire Veterans Affairs Medical Center, 1201 Broad Rock Blvd, Richmond, VA, USA
| | - Jose F Huizar
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Ste. 4A-100, Richmond, VA 23249, USA.,Hunter Holmes McGuire Veterans Affairs Medical Center, 1201 Broad Rock Blvd, Richmond, VA, USA
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22
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Larsen TR, Koneru JN, Padala SK, Kasirajan V, Ellenbogen KA. Spectrum of arrhythmogenic substrate post minimally invasive maze surgery in patients with recurrent. Pacing Clin Electrophysiol 2021; 44:1054-1061. [PMID: 33826173 DOI: 10.1111/pace.14242] [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: 01/20/2021] [Revised: 03/22/2021] [Accepted: 04/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Advancements in minimally invasive surgical ablation (MISA) have focused on improving pulmonary vein isolation. Additional ablation targets have been developed (such as posterior wall isolation). The mid- and long-term effects of current techniques (including electrophysiologic findings and recurrent arrhythmia mechanisms) have not previously been reported. METHODS Twenty eight patients with recurrent atrial arrhythmias after bipolar clamp ablation of the pulmonary vein antrum, ganglionated plexi, posterior wall isolation (roof and floor lines to create a posterior box), and ligament of Marshall ligation/cauterization and left atrial appendage clipping underwent follow up electrophysiology study including left atrial mapping an average of 2.3 years postoperatively. RESULTS Atrial fibrillation was the most common recurrent arrhythmia (n = 18) followed by micro-reentrant atrial tachycardia (n = 5), macro-reentry left atrial flutter (n = 3), and typical cavo-tricuspid isthmus atrial flutter (n = 2). Eighty six of 112 (77%) PVs mapped were electrically isolated, 16 (57%) patients had all four pulmonary veins (PVs) isolated. The posterior wall (PW) was completely isolated in only four (14%) patients, seven (25%) patients had normal PW voltage, while 17 (61%) patients had abnormal delayed or fractionated electrograms in the posterior wall (incomplete isolation). Abnormal PW electrograms were more frequently found in patients with complex recurrent left atrial arrhythmia (micro-reentry or left atrial macro-reentry flutter). CONCLUSION With current surgical techniques PV isolation has improved, but PW isolation remains challenging. Incomplete PW isolation may produce arrhythmogenic substrate.
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Affiliation(s)
- Timothy R Larsen
- Department of Cardiology, Division of Electrophysiology Rush University Medical Center, Chicago, Illinois, USA
| | - Jayanthi N Koneru
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Santosh K Padala
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Vigneshwar Kasirajan
- Division of Cardiac Surgery, Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Kenneth A Ellenbogen
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
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23
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Singleton MJ, Koneru JN, Bhave PD, Whalen SP. An Incessant Tachycardia: What Is the Mechanism? J Innov Card Rhythm Manag 2021; 12:4477-4481. [PMID: 33959407 PMCID: PMC8095334 DOI: 10.19102/icrm.2021.120407] [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] [Received: 06/11/2020] [Accepted: 10/07/2020] [Indexed: 11/25/2022] Open
Abstract
A 39-year-old man presented with lifelong palpitations, a mildly reduced left ventricular ejection fraction, and incessant tachycardia. Electrocardiography revealed a regular, one-to-one supraventricular tachycardia with superiorly directed P-waves and a long R–P interval. The differential diagnosis of the tachycardia, response to invasive electrophysiologic maneuvers, and treatment with catheter ablation are discussed.
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Affiliation(s)
- Matthew J Singleton
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jayanthi N Koneru
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VI, USA
| | - Prashant D Bhave
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - S Patrick Whalen
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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24
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Huizar JF, Fisher SG, Ramsey FV, Kaszala K, Tan AY, Moore H, Koneru JN, Kron J, Padala SK, Ellenbogen KA, Singh SN. Outcomes of Premature Ventricular Contraction-Cardiomyopathy in the Veteran Population: A Secondary Analysis of the CHF-STAT Study. JACC Clin Electrophysiol 2021; 7:380-390. [PMID: 33736756 PMCID: PMC9188841 DOI: 10.1016/j.jacep.2020.08.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/05/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study sought to assess the rate and outcomes of premature ventricular contractions (PVC)-cardiomyopathy from the CHF-STAT (Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure) trial, a population with cardiomyopathy (left ventricular [LV] ejection fraction of <40%) and frequent PVCs (>10 PVCs per hour). BACKGROUND PVCs are associated with heart failure and PVC-cardiomyopathy. The prevalence of PVC-cardiomyopathy and outcome benefits of PVC suppression are not clear. METHODS A secondary analysis of the CHF-STAT study was performed to compare the rate of successful PVC suppression (≥80% PVC reduction), LV recovery (defined as improvement in LV ejection fraction of ≥10% points), and PVC-cardiomyopathy between amiodarone and placebo groups at 6 months. PVC-cardiomyopathy was defined if both PVC reduction of ≥80% and LV ejection fraction improvement of ≥10% were present at 6 months. Cardiac events (death or resuscitated cardiac arrest) were compared between PVC-cardiomyopathy versus non-PVC-cardiomyopathy during a 5-year follow-up. RESULTS The rates of successful PVC suppression and LV recovery were significantly higher in the amiodarone (72% and 39%, respectively) when compared to the placebo group (12% and 16%, respectively; p < 0.001), regardless of cardiomyopathy etiology. PVC-cardiomyopathy was present in 29% and 1.8% of patients in the amiodarone and placebo groups, respectively (p < 0.001). Similar PVC-cardiomyopathy rates were found in ischemic (24% amiodarone vs. 2% placebo; p < 0.001) and nonischemic populations (41% amiodarone vs. 1.5% placebo; p < 0.001). Death and resuscitated cardiac arrest were significantly lower in patients with PVC-cardiomyopathy and those treated with amiodarone. CONCLUSIONS The overall prevalence of PVC-cardiomyopathy in the CHF-STAT study was significant regardless of ischemic substrate (29%, overall population; 41%, nonischemic cardiomyopathy). Treatment of PVC-cardiomyopathy with amiodarone is likely to improve survival in this high-risk population.
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Affiliation(s)
- Jose F Huizar
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA; Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA.
| | - Susan G Fisher
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Frederick V Ramsey
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Karoly Kaszala
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA; Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA
| | - Alex Y Tan
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA; Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA
| | - Hans Moore
- Washington Veterans Affairs Medical Center, Washington, DC, USA
| | - Jayanthi N Koneru
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA
| | - Jordana Kron
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA
| | - Santosh K Padala
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA
| | | | - Steven N Singh
- Washington Veterans Affairs Medical Center, Washington, DC, USA
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25
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Teigeler T, Kolominsky J, Vo C, Shepard RK, Kalahasty G, Kron J, Huizar JF, Kaszala K, Tan AY, Koneru JN, Ellenbogen KA, Padala SK. Intermediate-term performance and safety of His-bundle pacing leads: A single-center experience. Heart Rhythm 2021; 18:743-749. [PMID: 33418127 DOI: 10.1016/j.hrthm.2020.12.031] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/09/2020] [Accepted: 12/27/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The short-term safety, feasibility, and performance of His-bundle pacing (HBP) leads have been reported; however, their longer-term performance beyond 1 year remains unclear. OBJECTIVE The purpose of this study was to examine the intermediate-term performance and safety of HBP. METHODS All HBP lead implants at Virginia Commonwealth University between January 2014 and January 2019 were analyzed. HBP was performed using a Medtronic SelectSecure 3830-69 cm pacing lead. RESULTS Of 295 attempts, successful HBP implantation (selective or nonselective) was seen in 274 cases (93%). Mean follow-up duration was 22.8 ± 19.5 months (median 19.5; interquartile range 11-33). Mean age was 69 ± 15 years; 58% were males; and ejection fraction <50% was noted in 30%. Indications for pacemaker included sick sinus syndrome in 41%, atrioventricular block in 36%, cardiac resynchronization therapy in 7%, and refractory atrial fibrillation in 15%. Selective HBP was achieved in 33%. Mean HBP capture threshold at implant was 1.1 ± 0.9 V at 0.8 ± 0.2 ms, which significantly increased at chronic follow-up to 1.7 ± 1.1 V at 0.8 ± 0.3 ms (P <.001). Threshold was ≥2.5 V in 24% of patients, and 28% had an increase in HBP threshold ≥1 V. Loss of His-bundle capture at follow-up (septal right ventricular pacing) was seen in 17%. There was a total of 31 (11%) lead revisions, primarily for unacceptably high thresholds. CONCLUSION Although HBP can prevent or improve pacing-induced cardiomyopathy, the elevated capture thresholds, loss of His-bundle capture, and lead revision rates at intermediate follow-up are of concern. Longer-term follow-up data from multiple centers are needed.
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Affiliation(s)
- Todd Teigeler
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jeffrey Kolominsky
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Chau Vo
- Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Richard K Shepard
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Gautham Kalahasty
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jordana Kron
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jose F Huizar
- Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Karoly Kaszala
- Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Alex Y Tan
- Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Jayanthi N Koneru
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Santosh K Padala
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia.
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26
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Pillai A, Padala SK, Ellenbogen KA, Koneru JN. An Unusual Complication of Transseptal Puncture. JACC Case Rep 2021; 3:41-46. [PMID: 34317466 PMCID: PMC8305646 DOI: 10.1016/j.jaccas.2020.11.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 06/01/2023]
Abstract
The interatrial septum is a structure with complex embryological development. The true atrial septum is a circumscribed structure, and transgression outside of this area during transseptal puncture may result in entry into the extracardiac space or aorta that may result in a pericardial effusion or cardiac tamponade. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Ajay Pillai
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Santosh K. Padala
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kenneth A. Ellenbogen
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jayanthi N. Koneru
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
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27
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Padala SK, Master VM, Terricabras M, Chiocchini A, Garg A, Kron J, Shepard R, Kalahasty G, Azizi Z, Tsang B, Khaykin Y, Pantano A, Koneru JN, Ellenbogen KA, Verma A. Initial Experience, Safety, and Feasibility of Left Bundle Branch Area Pacing. JACC Clin Electrophysiol 2020; 6:1773-1782. [DOI: 10.1016/j.jacep.2020.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/19/2020] [Accepted: 07/05/2020] [Indexed: 02/01/2023]
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28
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Garg A, Koneru JN, Fagan DH, Stromberg K, Padala SK, El-Chami MF, Roberts PR, Piccini JP, Cheng A, Ellenbogen KA. Morbidity and mortality in patients precluded for transvenous pacemaker implantation: Experience with a leadless pacemaker. Heart Rhythm 2020; 17:2056-2063. [DOI: 10.1016/j.hrthm.2020.07.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 11/26/2022]
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29
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Vijayaraman P, Dandamudi G, Subzposh FA, Shepard RK, Kalahasty G, Padala SK, Strobel JS, Bauch TD, Ellenbogen KA, Bergemann T, Hughes L, Harris ML, Fagan DH, Yang Z, Koneru JN. Imaging-Based Localization of His Bundle Pacing Electrodes: Results From the Prospective IMAGE-HBP Study. JACC Clin Electrophysiol 2020; 7:73-84. [PMID: 33478715 DOI: 10.1016/j.jacep.2020.07.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/29/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to evaluate the correlation between His bundle (HB) pacing (HBP) implantation characteristics, lead-tip location, and association of intraprocedural His recordings with approximated HB anatomic landmarks using computed tomography (CT) imaging. BACKGROUND HBP continues to grow in clinical practice due to offering true physiological pacing. However, a clear understanding of HB anatomy and the lead-tip location's influence on pacing characteristics is lacking. METHODS The IMAGE-HBP study (Imaging Study of Lead Implant for His Bundle Pacing) was a prospective, multicenter study designed to assess implantation characteristics of the SelectSecure Model 3830 lead placed at the HB, evaluate protocol-specified HBP success (His recording present on electrogram and HBP threshold ≤2.5 V at 1 ms), and correlation between lead-tip location by CT imaging and HBP characteristics as well as lead-related complications through 12 months. RESULTS Sixty-nine patients underwent a lead implantation attempt at the HB. Of these, 61 patients (88%) had a lead successfully implanted at the HB, and 52 patients (75%) met the pre-specified definition of successful HBP. In 51 patients with CT imaging, 11 leads (22%) were placed in the atrial aspect of the HB region (36% selective HBP), and 40 leads (78%) were placed in the ventricular aspect (28% selective HBP). Four of the 51 patients had P-wave oversensing, all with leads in the atrium. Freedom from lead-related complication at 12 months was 93%. CONCLUSIONS Successful HBP could be achieved at lead-tip locations in the atrium or ventricle but is preferable in the ventricle to eliminate risk of oversensing. The IMAGE-HBP study offers better insight into approximated HB anatomic landmarks, lead-tip location, and correlation with pacing characteristics. (Imaging Study of Lead Implant for His Bundle Pacing [IMAGE-HBP]; NCT03294317).
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Affiliation(s)
| | - Gopi Dandamudi
- Division of Cardiology, Division of Cardiac Electrophysiology, Indiana University, Indianapolis, Indiana, USA
| | | | - Richard K Shepard
- Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA
| | - Gautham Kalahasty
- Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA
| | - Santosh K Padala
- Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA
| | - John S Strobel
- Division of Cardiology, Division of Cardiac Electrophysiology, Indiana University, Indianapolis, Indiana, USA
| | - Terry D Bauch
- Geisinger Heart Institute, Wilkes-Barre, Pennsylvania, USA
| | - Kenneth A Ellenbogen
- Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Lisa Hughes
- Medtronic, Inc., Mounds View, Minnesota, USA
| | | | | | | | - Jayanthi N Koneru
- Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA
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30
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Klein KM, Alwatari Y, Koneru JN, Smallfield G, Cassano AD, Shah RD. Deglutition Syncope Treated With Peroral Endoscopic Myotomy. Ann Thorac Surg 2020; 110:e473-e475. [PMID: 32492437 DOI: 10.1016/j.athoracsur.2020.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/19/2020] [Accepted: 04/07/2020] [Indexed: 11/24/2022]
Abstract
Deglutition syncope is a rare, neurally mediated reflex syncope associated with swallowing. It is typically associated with pharyngoesophageal disorders with secondary abnormal vagal reflex causing atrioventricular cardiac block and cerebral hypoperfusion. Diagnosis can be delayed and challenging. Various treatment options have been reported, including withholding cardiac blocker agents, diet modifications, and pacemaker placement. We present a case of persistent deglutition syncope secondary to esophagogastric junction outflow obstruction that failed medical therapy and was managed successfully with peroral endoscopic myotomy with excellent long-term outcome.
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Affiliation(s)
- Katherine M Klein
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Yahya Alwatari
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia.
| | - Jayanthi N Koneru
- Division of Cardiology, and Virginia Commonwealth University, Richmond, Virginia
| | - George Smallfield
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia
| | - Anthony D Cassano
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Rachit D Shah
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia
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31
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Abstract
Background Although there are considerable data on the safety of cryoablation, data on the rare but severe complication of atrioesophageal fistula (AEF) following cryoballoon ablation are limited. Objective To report the global, user-reported incidence of AEF associated with cryoballoon ablation for the treatment of atrial fibrillation using Medtronic's complaint database. Methods User-reported cryoballoon ablation complications occurring between July 1, 2009, and March 31, 2019, were reviewed to identify cases of AEF. A global event rate of AEF was calculated by dividing the event count by total catheter utilization over the same period. Data on symptoms and patient sequalae were reported as available. Results More than 500,000 Arctic Front cryoballoon catheters (Arctic Front, Arctic Front Advance, Arctic Front Advance ST, and Arctic Front Advance Pro; Medtronic, Inc) were distributed globally during the 9.75-year study period. During this time, 18 confirmed AEF, 1 suspected AEF, and 1 pericardial esophageal fistula were identified; therefore, global incidence of AEF associated with the Arctic Front family of ablation catheters was 0.00396%. Patients most commonly presented with fever (88.2%), and initial symptoms were reported a median of 21 (interquartile range: 4-30) days after the ablation. Although rare, the development of an AEF resulted in death in 68.8% (11/16) of patients with known outcomes. Conclusions AEF is a possible but rare complication of cryoballoon ablation with a reported frequency of 1 in every 25,000 patients treated. Awareness of the prevalence and manifestation of AEF associated with cryoballoon ablation is critical for early identification and treatment of this complication.
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Affiliation(s)
- Jonathan P Piccini
- Cardiac Electrophysiology Section, Duke University Medical Center & Duke Clinical Research Institute, Durham, North Carolina
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Abstract
Impedance is the ratio of voltage to current in an electrical circuit. Cardiovascular implantable electronic devices measure impedance to assess the structural integrity electrical performance of leads, typically using subthreshold pulses. We review determinants of impedance, how it is measured, variation in clinically measured pacing and high-voltage impedance and impedance trends as a diagnostic for lead failure and lead-device connection problems. We consider the differential diagnosis of abnormal impedance and the approach to the challenging problem of a single, abnormal impedance measurement. Present impedance provides a specific but insensitive diagnostic. For pacing circuits, we review the complementary roles of impedance and more sensitive oversensing diagnostics. Shock circuits lack a sensitive diagnostic. This deficiency is particularly important for insulation breaches, which may go undetected and present with short circuits during therapeutic shocks. We consider new methods for measuring impedance that may increase sensitivity for insulation breaches.
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Affiliation(s)
- Charles D. Swerdlow
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.)
| | - Jayanthi N. Koneru
- Division of Cardiology, VCU School of Medicine, Richmond, VA (J.N.K., K.A.E.)
| | | | | | - Sylvain Ploux
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (S.P.)
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France (S.P.)
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Trankle CR, Puckett L, Swift-Scanlan T, DeWilde C, Priday A, Sculthorpe R, Ellenbogen KA, Fowler A, Koneru JN. Vitamin C Intravenous Treatment In the Setting of Atrial Fibrillation Ablation: Results From the Randomized, Double-Blinded, Placebo-Controlled CITRIS-AF Pilot Study. J Am Heart Assoc 2020; 9:e014213. [PMID: 32013700 PMCID: PMC7033876 DOI: 10.1161/jaha.119.014213] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Catheter ablation is an effective treatment for atrial fibrillation (AF), but high levels of post‐procedure inflammation predict adverse clinical events. Ascorbic acid (AA) has shown promise in reducing inflammation but is untested in this population. We sought to test the feasibility, safety, and preliminary effects on inflammatory biomarkers in the CITRIS‐AF (Vitamin C Intravenous Treatment In the Setting of Atrial Fibrillation Ablation) pilot study. Methods and Results Patients scheduled to undergo AF ablation (N=20) were randomized 1:1 to double‐blinded treatment with AA (200 mg/kg divided over 24 hours) or placebo. C‐reactive protein and interleukin‐6 levels were obtained before the first infusion and repeated at 24 hours and 30 days. Pain levels within 24 hours and early recurrence of AF within 90 days were recorded. Median and interquartile range were aged 63 (56–70) years, 13 (65%) men, and 18 (90%) white. Baseline data were similar between the 2 groups except ejection fraction. Baseline C‐reactive protein levels were 2.56 (1.47–5.87) mg/L and similar between groups (P=0.48). Change in C‐reactive protein from baseline to 24 hours was +10.79 (+6.56–23.19) mg/L in the placebo group and +3.01 (+0.40–5.43) mg/L in the AA group (P=0.02). Conversely, change in interleukin‐6 was numerically higher in the AA group, though not statistically significant (P=0.32). One patient in each arm developed pericarditis; no adverse events related to the infusions were seen. There were no significant differences between aggregated post‐procedure pain levels within 24 hours or early recurrence of AF (both P>0.05). Conclusions High‐dose AA is safe and well tolerated at the time of AF ablation and may be associated with a blunted rise in C‐reactive protein, although consistent findings were not seen in interleukin‐6 levels. Further studies are needed to validate these findings and explore the potential benefit in improving clinically relevant outcomes. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03148236.
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Affiliation(s)
- Cory R Trankle
- Division of Cardiology Pauley Heart Center Virginia Commonwealth University Richmond VA
| | - Laura Puckett
- Johnson Center for Critical Care and Pulmonary Research Virginia Commonwealth University Richmond VA
| | | | - Christine DeWilde
- Johnson Center for Critical Care and Pulmonary Research Virginia Commonwealth University Richmond VA
| | - Anna Priday
- Johnson Center for Critical Care and Pulmonary Research Virginia Commonwealth University Richmond VA
| | - Robin Sculthorpe
- Investigational Drug Service Virginia Commonwealth University Richmond VA
| | - Kenneth A Ellenbogen
- Division of Cardiology Pauley Heart Center Virginia Commonwealth University Richmond VA
| | - Alpha Fowler
- Johnson Center for Critical Care and Pulmonary Research Virginia Commonwealth University Richmond VA.,Divison of Pulmonary Disease and Critical Care Medicine Department of Internal Medicine Virginia Commonwealth University Richmond VA
| | - Jayanthi N Koneru
- Division of Cardiology Pauley Heart Center Virginia Commonwealth University Richmond VA
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Saini A, Serafini NJ, Campbell S, Waugh WB, Zimberg R, Sheldon TJ, Kron J, Kalahasty G, Padala SK, Trohman R, Shepard RK, Koneru JN, Vijayaraman P, Ellenbogen KA, Sharma PS. Novel Method for Assessment of His Bundle Pacing Morphology Using Near Field and Far Field Device Electrograms. Circ Arrhythm Electrophysiol 2019; 12:e006878. [PMID: 30707036 DOI: 10.1161/circep.118.006878] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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 The 12-lead ECG is considered the gold standard to differentiate between selective (S), nonselective (NS) His bundle pacing (HBP), and right ventricular septal capture in routine clinical practice. We sought to assess the utility of device EGM recordings as a tool to identify the type of HBP morphology. METHODS One hundred forty-eight consecutive patients underwent HBP with a 3830 Select Secure lead (Medtronic, Inc) at 3 centers between October 2016 and October 2017. The near field V-EGM morphology (NF EGM), near field V-EGM time to peak (NFTime to peak), and far-field EGM QRS duration (QRSd) were recorded while pacing the His lead with simultaneous 12-lead ECG rhythm strips. RESULTS Indications for HBP were sinus node dysfunction, atrioventricular conduction disease, and cardiac resynchronization therapy in 68 (46%), 56 (38%), and 24 (16%) patients, respectively. Baseline QRSd was 108±38 ms with QRSd >120 ms in 57 (39%) patients (27 right bundle branch block, 18 left bundle branch block, and 12 intraventricular conduction delay). S-HBP was noted in 54 (36%) patients. A positive NFEGM and NFTime to peak >40 ms were highly sensitive (94% and 93%, respectively) and specific (90% and 94%) for S-HBP irrespective of baseline QRSd. All 3 parameters (+NFEGM, NFTime to peak >40 ms, and far-field EGM QRSd <120 ms) had high negative predictive value (97%, 95%, and 92%). A novel device-based algorithm for S-HBP was proposed. EGM transitions correlated with ECG transitions during threshold testing and can help accurately differentiate between S-HBP, NS-HBP, and right ventricular septal pacing with a cumulative positive predictive value of 91% (positive predictive value =100% in patients with baseline QRSd <120 ms). CONCLUSIONS We propose a novel and simple criteria for accurate differentiation between S-HBP, NS-HBP, and right ventricular septal capture morphologies by careful analysis of device EGMs alone. This study paves the way for future studies to assess autocapture algorithms for devices with HBP.
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Affiliation(s)
- Aditya Saini
- Division of Cardiac Electrophysiology, Virginia Commonwealth University Pauley Heart Center, Richmond (A.S., J.K., G.K., S.K.P., R.K.S., J.N.K., K.A.E.)
| | - Nicholas J Serafini
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL (N.J.S., R.Z., R.T., P.S.S.)
| | | | | | - Ryan Zimberg
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL (N.J.S., R.Z., R.T., P.S.S.)
| | | | - Jordana Kron
- Division of Cardiac Electrophysiology, Virginia Commonwealth University Pauley Heart Center, Richmond (A.S., J.K., G.K., S.K.P., R.K.S., J.N.K., K.A.E.)
| | - Gautham Kalahasty
- Division of Cardiac Electrophysiology, Virginia Commonwealth University Pauley Heart Center, Richmond (A.S., J.K., G.K., S.K.P., R.K.S., J.N.K., K.A.E.)
| | - Santosh K Padala
- Division of Cardiac Electrophysiology, Virginia Commonwealth University Pauley Heart Center, Richmond (A.S., J.K., G.K., S.K.P., R.K.S., J.N.K., K.A.E.)
| | - Richard Trohman
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL (N.J.S., R.Z., R.T., P.S.S.)
| | - Richard K Shepard
- Division of Cardiac Electrophysiology, Virginia Commonwealth University Pauley Heart Center, Richmond (A.S., J.K., G.K., S.K.P., R.K.S., J.N.K., K.A.E.)
| | - Jayanthi N Koneru
- Division of Cardiac Electrophysiology, Virginia Commonwealth University Pauley Heart Center, Richmond (A.S., J.K., G.K., S.K.P., R.K.S., J.N.K., K.A.E.)
| | | | - Kenneth A Ellenbogen
- Division of Cardiac Electrophysiology, Virginia Commonwealth University Pauley Heart Center, Richmond (A.S., J.K., G.K., S.K.P., R.K.S., J.N.K., K.A.E.)
| | - Parikshit S Sharma
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL (N.J.S., R.Z., R.T., P.S.S.)
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Lüker J, Padala SK, Cano Ó, Beiert T, Osswald B, Koneru JN, Schrickel JW, Kron J, Franqui-Rivera H, Gonzalez-Cordero A, Al-Ghamdi BS, Roberts PR, Ceresnak SR, von Alvensleben J, Sultan A, Steven D. Multicenter Experience of Subcutaneous Implantable Cardioverter-Defibrillator Therapy in Patients With Dextrocardia. JACC Clin Electrophysiol 2019; 5:1226-1228. [PMID: 31648749 DOI: 10.1016/j.jacep.2019.07.010] [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] [Received: 06/03/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 10/25/2022]
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Garg A, Koneru JN, Fagan D, Stromberg K, El-Chami MF, Piccini JP, Roberts PR, Soejima K, Cheng A, Ellenbogen KA. 5970Morbidity and mortality in patients precluded for transvenous pacemaker implantation: experience with the Micra transcatheter pacemaker. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Micra transcatheter pacemaker has proven to be a safe and effective alternative to transvenous pacemakers (TVPs). However, the safety profile after Micra implantation in patients deemed poor candidates for TVPs is poorly understood.
Purpose
To evaluate the safety and all-cause mortality outcomes in Micra recipients stratified by whether or not they were precluded for therapy with TVP.
Methods
Micra patients from the Micra Transcatheter Pacing (IDE) Study, Continued Access (CA) study, and Post-Approval Registry (PAR) were divided into groups based upon whether or not the implanting physician considered the patient to be precluded from receiving a transvenous pacing system. All-cause mortality was compared between the Micra patient groups and patients receiving a single-chamber transvenous pacing system (SC-TVP) since 2010 from the Medtronic product surveillance registry using univariate and multivariate Cox models.
Results
Among 2,819 patients who underwent a Micra implant attempt, the overall major complication rate through 24 months was 3.5%. In these patients, 548 were deemed precluded from TVP implantation. Prior device infection or bacteremia (38.9%), venous access issues (36.1%) and thrombosis (10.2%) were amongst the most common causes of preclusion for TVP implantation. These patients were younger (71.7 vs. 76.7 years), more frequently on hemodialysis (26.3% vs. 2.5%), and more often had a prior CIED implanted (38.4% vs. 4.4%) than non-precluded patients. Over an average follow-up of 13.5±11.1 months, all-cause mortality was significantly higher in precluded Micra patients compared with SC-TVP patients (HR: 2.16, 95% CI: 1.54–3.2, P<0.001) (Figure 1). However, there was no significant difference in all-cause mortality when comparing non-precluded Micra patients and SC-TVP patients (HR: 1.12, 95% CI: 0.86–1.44, P=0.401). Acute all-cause death (within 1 month) among Micra patients was 2.74% and 1.32% in the precluded and non-precluded TVP groups, respectively. The procedure-related death rate was 0.55% for the TVP precluded group and 0.13% for the not precluded group (P=0.092). The major complication rate through 24-months was similar between the two Micra groups (4.0% vs 3.4%, P=0.630).
All-cause mortality for Micra and SC-TVP
Conclusion
The overall safety profile of Micra remains is in line with previously reported data. All-cause mortality risk (both acute and long term) appears to be higher in patients who were precluded from receiving TVP.
Acknowledgement/Funding
Supported by Medtronic
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Affiliation(s)
- A Garg
- Virginia Commonwealth University, Richmond, United States of America
| | - J N Koneru
- Virginia Commonwealth University, Richmond, United States of America
| | - D Fagan
- Medtronic, Mounds View, Minnesota, United States of America
| | - K Stromberg
- Medtronic, Mounds View, Minnesota, United States of America
| | - M F El-Chami
- Emory University, Atlanta, United States of America
| | - J P Piccini
- Duke Clinical Research Institute, Durham, United States of America
| | - P R Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - A Cheng
- Medtronic, Mounds View, Minnesota, United States of America
| | - K A Ellenbogen
- Virginia Commonwealth University, Richmond, United States of America
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37
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Teigeler T, Stahura H, Alimohammad R, Kalahasty G, Koneru JN, Ellenbogen M, Ellenbogen KA, Padala SK. Electrocardiographic changes in loperamide toxicity: Case report and review of literature. J Cardiovasc Electrophysiol 2019; 30:2618-2626. [DOI: 10.1111/jce.14129] [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: 02/03/2019] [Revised: 06/16/2019] [Accepted: 08/08/2019] [Indexed: 01/18/2023]
Affiliation(s)
- Todd Teigeler
- Division of Cardiac Electrophysiology Virginia Commonwealth University Richmond Virginia
| | - Heather Stahura
- Capital Cardiology Associates Albany Medical Center Albany New York
| | | | - Gautham Kalahasty
- Division of Cardiac Electrophysiology Virginia Commonwealth University Richmond Virginia
| | - Jayanthi N. Koneru
- Division of Cardiac Electrophysiology Virginia Commonwealth University Richmond Virginia
| | - Michael Ellenbogen
- Division of General Internal Medicine Johns Hopkins University School of Medicine Baltimore Maryland
| | - Kenneth A. Ellenbogen
- Division of Cardiac Electrophysiology Virginia Commonwealth University Richmond Virginia
| | - Santosh K. Padala
- Division of Cardiac Electrophysiology Virginia Commonwealth University Richmond Virginia
- Capital Cardiology Associates Albany Medical Center Albany New York
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38
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Gunda S, Akyeampong D, Gomez-Arroyo J, Jovin DG, Kowlgi NG, Kaszala K, Tan AY, Koneru JN, Kron J, Ellenbogen KA, Huizar JF. Consequences of chronic frequent premature atrial contractions: Association with cardiac arrhythmias and cardiac structural changes. J Cardiovasc Electrophysiol 2019; 30:1952-1959. [PMID: 31310360 DOI: 10.1111/jce.14067] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/22/2019] [Accepted: 06/24/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Frequent premature ventricular contractions (PVCs) can cause cardiomyopathy (CM). Postextrasystolic potentiation (PESP) and irregularity have been in implicated as triggers of PVC-CM. Because both phenomena can also be found in premature atrial contractions (PACs), it is speculated that frequent PACs have similar consequences. METHODS AND RESULTS A single-center, retrospective study included all consecutive patients undergoing a 14-day Holter monitors (November 2014 to October 2016). Patients were divided into four groups by ectopy burden group 1 (<1%) and remaining by tertiles (group 2-4). Echocardiographic and arrhythmic data were compared between PAC and PVC burdens. In addition, a translational PAC animal model was used to assess the chronic effects of frequent PACs. A total 846 patients were reviewed. In contrast to PVCs, we found no difference in left ventricular ejection fraction (LVEF), end-systolic and end-diastolic dimensions and presence of CM (LVEF <50%) between different PAC groups. Multivariate regression analysis demonstrated that only PVC burden predicted low EF (odds ratio, 1.1; confidence interval, 1.03-1.13; P = .001). While there was a weak correlation between PAC burden and supraventricular tachycardia (SVT) episodes and atrial fibrillation (AF) burden (r = 0.19; P < .001), there was no correlation between PAC burden and LVEF or CM. Finally, atrial bigeminy in our animal model did not significantly decrease LVEF after 3 months. CONCLUSION PAC burden is associated with increased AF and SVT episodes. In contrast to a high PVC burden, a high PAC burden is not associated with CM. Our findings suggest that heart rate irregularity and/or PESP may play a minimal role in the pathophysiology of PVC-CM.
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Affiliation(s)
- Sampath Gunda
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Daniel Akyeampong
- Cardiology Division, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Jose Gomez-Arroyo
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.,Cardiology Division, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Daniel G Jovin
- Cardiology Division, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Narayan G Kowlgi
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Karoly Kaszala
- Cardiology Division, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Alex Y Tan
- Cardiology Division, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Jayanthi N Koneru
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Jordana Kron
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | | | - Jose F Huizar
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.,Cardiology Division, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
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Koneru JN, Ellenbogen KA. ELECTRa—from myth to aletheia: risk factors for transvenous lead extraction in the ancillary analysis of the European Lead Extraction ConTRolled (ELECTRa) study. Europace 2019; 21:688-689. [DOI: 10.1093/europace/euy324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jayanthi N Koneru
- VCU Pauley Heart Center at the VCU School of Medicine, Richmond, VA, USA
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40
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Affiliation(s)
- Aditya Saini
- Division of Cardiac Electrophysiology, Virginia Commonwealth University Pauley Heart Center, Richmond
| | - Santosh K Padala
- Division of Cardiac Electrophysiology, Virginia Commonwealth University Pauley Heart Center, Richmond
| | - Jayanthi N Koneru
- Division of Cardiac Electrophysiology, Virginia Commonwealth University Pauley Heart Center, Richmond
| | - Kenneth A Ellenbogen
- Division of Cardiac Electrophysiology, Virginia Commonwealth University Pauley Heart Center, Richmond
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41
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Larsen TR, Saini H, Saini A, Loeffler J, Ellenbogen KA, Koneru JN. Anomalous pacing in a biventricular device due to spontaneous premature beats: What is the mechanism? Pacing Clin Electrophysiol 2019; 42:739-742. [PMID: 30924155 DOI: 10.1111/pace.13677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/19/2019] [Accepted: 03/26/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Timothy R Larsen
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Harsimran Saini
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Aditya Saini
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jeannie Loeffler
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jayanthi N Koneru
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
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Gunda S, Padala SK, Saini A, Kang L, Ellenbogen KA, Koneru JN. Risk score model for predicting complications in patients undergoing ventricular tachycardia ablation: insights from the National Inpatient Sample database. Europace 2019; 21:475-483. [PMID: 30304357 DOI: 10.1093/europace/euy213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/03/2018] [Accepted: 09/01/2018] [Indexed: 11/14/2022] Open
Abstract
AIMS Outcome data on ventricular tachycardia (VT) ablation has been limited to few experienced centres. We sought to identify complication rates, predictors, and create a risk score model for predicting complications in patients from real-world data. METHODS AND RESULTS A total of 25 451 patients undergoing VT ablation from year 2006 to 2013 were identified from the National Inpatient Sample (NIS) database. The whole cohort was randomly divided into derivation cohort to derive the model and validation cohort to validate the model. Multivariate predictors of any complication were identified using regression model. Each predictor was assigned a risk score and each patient was assigned to one of the four groups (risk score in parenthesis) based on total combined risk score: Group 0 (0), Group 1 (1-5), Group 2 (6-10), and Group 3 (>11). The rate of 'any complication' and 'in-hospital mortality' in whole cohort was 14.7% and 2.8%, respectively. The predictors of any complication include chronic kidney disease, coagulopathy, chronic liver disease, stroke (cerebrovascular accident), emergency procedure, age ≥ 65 years, coronary artery disease, peripheral vascular disease, and female gender. There was a significant increase in complication rate in a linear fashion as the risk score increased. The incidence of any complications increased from 2.7% in Group 0 to 31% in Group 3. The risk score model performed well in predicting complications associated with VT ablation. CONCLUSION Patients with higher risk scores have significant increase in any complication and in-hospital mortality from VT ablation. The simple risk score model can help to risk stratify patients prior to VT ablation.
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Affiliation(s)
- Sampath Gunda
- Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Gateway Building, 3rd Floor, 3-216, 1200 East Marshall St, Richmond, VA, USA
| | - Santosh K Padala
- Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Gateway Building, 3rd Floor, 3-216, 1200 East Marshall St, Richmond, VA, USA
| | - Aditya Saini
- Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Gateway Building, 3rd Floor, 3-216, 1200 East Marshall St, Richmond, VA, USA
| | - Le Kang
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Gateway Building, 3rd Floor, 3-216, 1200 East Marshall St, Richmond, VA, USA
| | - Jayanthi N Koneru
- Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Gateway Building, 3rd Floor, 3-216, 1200 East Marshall St, Richmond, VA, USA
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Padala SK, Gunda S, Li S, Sharma PS, Koneru JN, Varosy PD, Ellenbogen KA. A risk score model for predicting intraprocedural cardiac injury during implantable cardioverter defibrillator implantation: Insights from the National Cardiovascular Data Registry. J Cardiovasc Electrophysiol 2019; 30:212-220. [PMID: 30575180 DOI: 10.1111/jce.13823] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/29/2018] [Accepted: 11/12/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Individual risk factors of intraprocedural cardiac injury (cardiac perforation and tamponade) during implantable cardioverter defibrillator (ICD) placement have been documented. However, the prognostic impact of their coexistence has not been explored. OBJECTIVE To develop a risk score model to identify patients at risk for intraprocedural cardiac injury. METHODS We identified 438 679 patients from National Cardiovascular Data Registry (NCDR)-ICD who underwent de novo ICD implantation between 2010 and 2015, split randomly into a derivation cohort (n = 220 000) and a validation cohort (n = 218 679). The generalized estimating equations (GEEs) analysis with quasilikelihood under the independence model criterion goodness-of-fit statistics were used to identify the predictors of intraprocedural cardiac injury and a risk scoring model was developed. Model discrimination was assessed by receiver-operator characteristic curve and C-statistic. RESULTS The risk of intraprocedural cardiac injury in the overall cohort was 0.13%. GEE analysis yielded seven variables (points in parentheses) that were strongly associated with intraprocedural cardiac injury: age, greater than 75 years (1), female gender (1), body mass index, less than 18.5 kg/m 2 (1), hypertension (1), chronic lung disease (1), left bundle branch block (1), and continued warfarin use (1). Only prior history of coronary artery bypass grafting (CABG) (-1) was associated with reduced risk. A risk scoring system was developed that had good discrimination with a C-statistic of 0.72. The risk of intraprocedural cardiac injury increased with the increase in risk score from low risk (0.03%) to high risk (1.37%). CONCLUSION A practical risk score model can stratify patients into high- and low-risk groups for cardiac perforation or tamponade before undergoing ICD implantation.
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Affiliation(s)
- Santosh K Padala
- Divison of Cardiology, Department of Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Sampath Gunda
- Divison of Cardiology, Department of Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Shelby Li
- Department of Cardiac Rhythm and Heart Failure, Medtronic PLC, Minneapolis, Minnesota
| | - Parikshit S Sharma
- Divison of Cardiology, Department of Electrophysiology, Rush University Medical Center, Chicago, Illinois
| | - Jayanthi N Koneru
- Divison of Cardiology, Department of Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Paul D Varosy
- Division of Cardiology, Department of Electrophysiology, VA Eastern Colorado Health Care System, University of Colorado, Denver, Colorado
| | - Kenneth A Ellenbogen
- Divison of Cardiology, Department of Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
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Abstract
Because there has been a significant push toward His bundle pacing (HBP), multiple studies and advancements are underway to provide new and improved delivery tools and lead designs, allowing one to apply this technology in daily practice. A better understanding of the pacing configurations and ultimately development of dedicated algorithms will alleviate some of these aforementioned challenges. Ultimately, with such technological advances and mounting clinical evidence, one can surely anticipate HBP to revolutionize the field of cardiac pacing.
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Affiliation(s)
- Harsimran Saini
- VCU School of Medicine, Medical College of Virginia Hospitals, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- VCU School of Medicine, Medical College of Virginia Hospitals, Richmond, VA, USA.
| | - Jayanthi N Koneru
- VCU School of Medicine, Medical College of Virginia Hospitals, Richmond, VA, USA
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Trankle CR, Gertz ZM, Koneru JN, Kasirajan V, Nicolato P, Bhardwaj HL, Ellenbogen KA, Kalahasty G. Severe tricuspid regurgitation due to interactions with right ventricular permanent pacemaker or defibrillator leads. Pacing Clin Electrophysiol 2018; 41:845-853. [PMID: 29757467 DOI: 10.1111/pace.13369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 11/30/2022]
Abstract
Although thought to be a rare event, permanent pacemakers and implantable cardioverter-defibrillators with right ventricular intracardiac leads have the potential to induce tricuspid valve dysfunction. Adverse lead-valve interactions can take place through a variety of mechanisms including damage at the time of implantation, leaflet pinning, or long-term fibrosis encapsulating the leaflet tissue. Clinical manifestations can display a wide range of severity, as well as a highly variable time span between implantation and hemodynamic deterioration. This review aims to describe the potential pathophysiologic effects of intracardiac device leads on the tricuspid valve, with a focus on ideal diagnostic strategies and treatment options once lead-induced valvular dysfunction is suspected.
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Affiliation(s)
- Cory R Trankle
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Zachary M Gertz
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Jayanthi N Koneru
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Vigneshwar Kasirajan
- Division of Cardiothoracic Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Patricia Nicolato
- Division of Cardiothoracic Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Hem L Bhardwaj
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Gautham Kalahasty
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
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Koneru JN, Jones PW, Hammill EF, Wold N, Ellenbogen KA. Risk Factors and Temporal Trends of Complications Associated With Transvenous Implantable Cardiac Defibrillator Leads. J Am Heart Assoc 2018; 7:JAHA.117.007691. [PMID: 29748177 PMCID: PMC6015312 DOI: 10.1161/jaha.117.007691] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The transvenous implantable cardioverter‐defibrillator (ICD) lead is the most common source of complications in a traditional ICD system. This investigation aims to determine the incidence, predictors, and costs associated with these complications using a large insurance database. Methods and Results Data from the OptumLabs™ Data Warehouse, which include diagnosis, physician and procedure codes, and claims from patient hospitalizations, were analyzed. Patients with a de novo ICD or cardiac resynchronization therapy defibrillator implanted from January 1, 2003, through June 30, 2015, were included; those who did not have continuous coverage beginning 1 year before implantation were excluded, resulting in 40 837 patients followed up over an average of 2.3±2.1 years. Patients were followed up until they had the procedure or their last active date in the database. Of 20 580 device procedures, 2165 (5.3%) and 771 (1.9%) had mechanical and infectious complications, respectively. The 5‐year rate of freedom from mechanical complication was 92.0% and 89.3% for ICDs and cardiac resynchronization therapy defibrillators, respectively. Infectious complications were more likely in patients with a history of atrial fibrillation, diabetes mellitus, and renal disease, and the risk increased with subsequent device procedures. Younger age, female sex, lack of comorbidities, and implantations between 2003 and 2008 were associated with more mechanical complications. Conclusions Incidence of mechanical and infectious complications of transvenous ICD leads over long‐term follow‐up is much higher in the real world than in clinical studies. In our study cohort, 1 of 4 transvenous ICD leads had mechanical complications when followed up to 10 years. The high rate of reintervention leads to additional complications.
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Affiliation(s)
- Jayanthi N Koneru
- VCU School of Medicine, Medical College of Virginia Hospitals, Richmond, VA
| | - Paul W Jones
- Boston Scientific, Marlborough, MA.,OptumLabs, Cambridge, MA
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Zanon F, Ellenbogen KA, Dandamudi G, Sharma PS, Huang W, Lustgarten DL, Tung R, Tada H, Koneru JN, Bergemann T, Fagan DH, Hudnall JH, Vijayaraman P. Permanent His-bundle pacing: a systematic literature review and meta-analysis. Europace 2018; 20:1819-1826. [DOI: 10.1093/europace/euy058] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/10/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, 140, Viale Tre Martiri, Rovigo, Italy
| | | | - Gopi Dandamudi
- Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Parikshit S Sharma
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Daniel L Lustgarten
- Department of Internal Medicine, Division of Cardiology, University of Vermont College of Medicine, Burlington, VT, USA
| | - Roderick Tung
- University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Chicago, IL, USA
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Jayanthi N Koneru
- Division of Cardiology, Virginia Commonwealth University, Richmond, VA, USA
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Saini A, Huizar JF, Tan A, Koneru JN, Ellenbogen KA, Kaszala K. Scar Homogenization in Atrial Fibrillation Ablation: Evolution and Practice. J Atr Fibrillation 2017; 10:1645. [PMID: 29250241 DOI: 10.4022/jafib.1645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/19/2017] [Accepted: 09/14/2017] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) ablation has emerged as the preferred rhythm control strategy for symptomatic paroxysmal AF refractory or intolerant to at least one class I or III antiarrhythmic medication. Since the initial observation by Haissaguerre and colleagues, of pulmonary vein triggers initiating atrial fibrillation (AF), pulmonary vein isolation (PVI) has become the cornerstone for paroxysmal AF ablation therapy.
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Affiliation(s)
- Aditya Saini
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
| | - Jose F Huizar
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
| | - Alex Tan
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
| | - Jayanthi N Koneru
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
| | - Kenneth A Ellenbogen
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
| | - Karoly Kaszala
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
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Affiliation(s)
- Santosh K Padala
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jayanthi N Koneru
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
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Padala SK, Gunda S, Sharma PS, Kang L, Koneru JN, Ellenbogen KA. Risk model for predicting complications in patients undergoing atrial fibrillation ablation. Heart Rhythm 2017; 14:1336-1343. [DOI: 10.1016/j.hrthm.2017.04.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Indexed: 01/28/2023]
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