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Baroutidou A, Otountzidis N, Papazoglou AS, Moysidis DV, Kartas A, Mantziari L, Kamperidis V, Ziakas A, Giannakoulas G. Atrial Fibrillation Ablation in Congenital Heart Disease: Therapeutic Challenges and Future Perspectives. J Am Heart Assoc 2024; 13:e032102. [PMID: 38193287 PMCID: PMC10926799 DOI: 10.1161/jaha.123.032102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024]
Abstract
The increasing prevalence of atrial fibrillation (AF) in adults with congenital heart disease raises significant questions regarding its management. The unique underlying anatomic and physiological background further adds to the difficulty in eliminating the AF burden in these patients. Herein, we provide an overview of the current knowledge on the pathophysiology and risk factors for AF in adult congenital heart disease, with a special focus on the existing challenges in AF ablation. Emerging imaging modalities and ablation techniques might have a role to play. Evidence regarding the safety and efficacy of AF ablation in adult congenital heart disease is summarized, especially for patients with an atrial septal defect, Ebstein anomaly of the tricuspid valve, tetralogy of Fallot, and Fontan circulation. Finally, any remaining gaps in knowledge and potential areas of future research are highlighted.
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Affiliation(s)
- Amalia Baroutidou
- First Department of CardiologyAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Nikolaos Otountzidis
- First Department of CardiologyAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | | | | | - Anastasios Kartas
- First Department of CardiologyAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | | | - Vasileios Kamperidis
- First Department of CardiologyAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Antonios Ziakas
- First Department of CardiologyAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - George Giannakoulas
- First Department of CardiologyAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
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Vassilikos VP, Giannopoulos G, Billis A, Efremidis M, Andrikopoulos G, Katsivas A, Kossyvakis C, Kallergis E, Letsas K, Kanoupakis E, Ioannidis P, Tzeis S, Deftereos S, Tsiachris D, Theodorakis G, Maounis T, Lysitsas D, Chatzinikolaou E, Fragakis N, Paraskevaidis S, Mezilis N, Kourouklis S, Pastromas S, Apostolopoulos T, Avramidis D, Chatzidou S, Papagiannis I, Kostopoulou A, Symeonidou E, Rassias I, Mantziari L, Leventopoulos G, Kourgiannidis G, Stavropoulos G, Katritsis D, Chiladakis I, Xydonas S, Ginos C, Kotsakis A, Baltogiannis G, Manolis AS, Sideris S, Gatzoulis K. Effect of the COVID-19 pandemic on cardiac electrophysiological ablation procedures in Greece - data from the Hellenic Society of Cardiology Ablation Registry. Hellenic J Cardiol 2022; 67:76-78. [PMID: 35811060 PMCID: PMC9263686 DOI: 10.1016/j.hjc.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/03/2022] [Accepted: 07/03/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vassilios P Vassilikos
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki
| | - Georgios Giannopoulos
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki.
| | - Antonis Billis
- Lab of Medical Physics, Aristotle University of Thessaloniki, Thessaloniki
| | - Michalis Efremidis
- Onassis Cardiothoracic Center, Department of Electrophysiology and Pacing, Athens
| | | | | | | | - Eleftherios Kallergis
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Heraklion
| | - Konstantinos Letsas
- Onassis Cardiothoracic Center, Department of Electrophysiology and Pacing, Athens
| | - Emmanouel Kanoupakis
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Heraklion
| | | | | | - Spyridon Deftereos
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens
| | | | | | - Themistoklis Maounis
- Onassis Cardiothoracic Center, Department of Electrophysiology and Pacing, Athens
| | | | | | - Nikolaos Fragakis
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki
| | - Stylianos Paraskevaidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki
| | | | | | | | | | | | - Sophia Chatzidou
- Alexandra University Hospital, National and Kapodistrian University of Athens, Athens
| | | | - Anna Kostopoulou
- Onassis Cardiothoracic Center, Department of Electrophysiology and Pacing, Athens
| | - Eftychia Symeonidou
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens
| | | | | | | | | | - George Stavropoulos
- Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki
| | | | - Ioannis Chiladakis
- Department of Cardiology, Rio University Hospital, University of Patras, Patras
| | | | | | | | - Giannis Baltogiannis
- Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina
| | - Antonis S Manolis
- First Department of Cardiology, Hippokration University Hospital, National and Kapodistrian University of Athens, Athens
| | - Skevos Sideris
- First Department of Cardiology, Hippokration University Hospital, National and Kapodistrian University of Athens, Athens
| | - Konstantinos Gatzoulis
- First Department of Cardiology, Hippokration University Hospital, National and Kapodistrian University of Athens, Athens
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Mantziari L, Butcher C, Shi R, Kontogeorgis A, Opel A, Chen Z, Haldar S, Panikker S, Hussain W, Jones DG, Gatzoulis MA, Markides V, Ernst S, Wong T. Characterization of the Mechanism and Substrate of Atrial Tachycardia Using Ultra-High-Density Mapping in Adults With Congenital Heart Disease: Impact on Clinical Outcomes. J Am Heart Assoc 2020; 8:e010535. [PMID: 30773973 PMCID: PMC6405650 DOI: 10.1161/jaha.118.010535] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 11/24/2022]
Abstract
Background Atrial tachycardia (AT) is common in patients with adult congenital heart disease and is challenging to map and ablate. We used ultra‐high‐density mapping to characterize the AT mechanism and investigate whether substrate characteristics are related to ablation outcomes. Methods and Results A total of 50 ATs were mapped with ultra‐high‐density mapping in 23 procedures. Patients were followed up for up to 12 months. Procedures were classified to group A if there was 1 single AT induced (n=12) and group B if there were ≥2 ATs induced (n=11 procedures). AT mechanism per procedure was macro re‐entry (n=10) and localized re‐entry (n=2) in group A and multiple focal (n=6) or multiple macro re‐entry (n=5) in group B. Procedure duration, low voltage area (0.05–0.5 mV), and low voltage area indexed for volume were higher in group B (159 [147–180] versus 412 [352–420] minutes, P<0.001, 22.6 [12.2–29.8] versus 54.2 [51.1–61.6] cm2, P=0.014 and 0.17 [0.12–0.21] versus 0.26 [0.23–0.27] cm2/mL, P=0.024 accordingly). Dense scar (<0.05 mV) and atrial volume were similar between groups. Acute success and freedom from arrhythmia recurrence were worse in group B (100% versus 77% P=0.009 and 11.3, CI 9.8–12.7 versus 4.9, CI 2.2–7.6 months, log rank P=0.004). Indexed low voltage area ≥0.24 cm2/mL could predict recurrence with 100% sensitivity and 77% specificity (area under the curve 0.923, P=0.007). Conclusions Larger low voltage area but not dense scar is associated with the induction of multiple focal or re‐entry ATs, which are subsequently associated with longer procedure duration and worse acute and midterm clinical outcomes.
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Affiliation(s)
- Lilian Mantziari
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Charles Butcher
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Rui Shi
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | | | - Aaisha Opel
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Zhong Chen
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Shouvik Haldar
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Sandeep Panikker
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Wajid Hussain
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - David Gareth Jones
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | | | - Vias Markides
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Sabine Ernst
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Tom Wong
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
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Shi R, Chen Z, Mantziari L, Wong T. Multiple atrial tachycardias after orthotopic heart transplantation: A case report and literature review. HeartRhythm Case Rep 2018; 4:538-541. [PMID: 30479955 PMCID: PMC6241167 DOI: 10.1016/j.hrcr.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cazzoli I, Guarguagli S, Roy K, Ueda A, Gomez F, Horduna IS, Mantziari L, Babu-Narayan SV, Ernst S. 219Arrhythmia substrates in patients after Total Cavo-Pulmonary Connection (TCPC): a single centre experience using remote magnetic navigation. Europace 2018. [DOI: 10.1093/europace/euy015.068] [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: 11/15/2022] Open
Affiliation(s)
- I Cazzoli
- Royal Brompton Hospital, Adult and Congenital Heart Centre & Centre for Pulmonary Hypertension. Department of Cardiology, London, United Kingdom
| | - S Guarguagli
- Royal Brompton Hospital, Department of Cardiology, London, United Kingdom
| | - K Roy
- Royal Brompton Hospital, Department of Cardiology, London, United Kingdom
| | - A Ueda
- Royal Brompton Hospital, Department of Cardiology, London, United Kingdom
| | - F Gomez
- Royal Brompton Hospital, Department of Cardiology, London, United Kingdom
| | - I S Horduna
- Royal Brompton Hospital, Department of Cardiology, London, United Kingdom
| | - L Mantziari
- Royal Brompton Hospital, Department of Cardiology, London, United Kingdom
| | - S V Babu-Narayan
- Royal Brompton Hospital, Department of Cardiology. Cardiovascular Research Center, National H&L Institute, Imperial College, London, United Kingdom
| | - S Ernst
- Royal Brompton Hospital, Department of Cardiology. Cardiovascular Research Center, National H&L Institute, Imperial College, London, United Kingdom
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Haldar SK, Jones DG, Bahrami T, De Souza A, Panikker S, Butcher C, Khan H, Yahdav R, Jarman J, Mantziari L, Nyktari E, Mohiaddin R, Hussain W, Markides V, Wong T. Catheter ablation vs electrophysiologically guided thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: The CASA-AF Study. Heart Rhythm 2017; 14:1596-1603. [DOI: 10.1016/j.hrthm.2017.08.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 10/18/2022]
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Shabeeh H, Hodkinson E, Mantziari L, Hussain W, Markides V, Wong T, Jones DG. P908Fluoroscopy-free catheter ablation of atrial fibrillation. Europace 2017. [DOI: 10.1093/ehjci/eux151.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shi R, Viswanathan K, Mantziari L, Butcher C, Lim E, Khan H, Panikker S, Hussain W, Haldar S, Jones D, Ernst S, Foran J, Markides V, Wong T. P1464Acute and medium-term outcomes following ablation of complex scar-related atrial tachycardia using a high-resolution mapping system. Europace 2017. [DOI: 10.1093/ehjci/eux158.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Boutou AK, Franks R, Mohan D, Mantziari L, Wong T, Hopkinson NS, Polkey MI. Exercise-induced changes in QT interval are smaller in COPD patients and have no impact on mortality. Eur Respir J 2017; 49:49/3/1602394. [PMID: 28298404 DOI: 10.1183/13993003.02394-2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/17/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Afroditi K Boutou
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield, NHS Foundation Trust, London, UK
| | - Russell Franks
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield, NHS Foundation Trust, London, UK
| | - Divya Mohan
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield, NHS Foundation Trust, London, UK
| | - Lilian Mantziari
- NIHR Cardiovascular Biomedical Research Unit at Royal Brompton and Harefield, NHS Foundation Trust, London, UK
| | - Tom Wong
- NIHR Cardiovascular Biomedical Research Unit at Royal Brompton and Harefield, NHS Foundation Trust, London, UK
| | - Nicholas S Hopkinson
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield, NHS Foundation Trust, London, UK
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield, NHS Foundation Trust, London, UK
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Panikker S, Lord J, Jarman JWE, Armstrong S, Jones DG, Haldar S, Butcher C, Khan H, Mantziari L, Nicol E, Hussain W, Clague JR, Foran JP, Markides V, Wong T. Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation. Eur Heart J 2016; 37:3470-3482. [PMID: 26935273 PMCID: PMC5841215 DOI: 10.1093/eurheartj/ehw048] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 11/16/2015] [Accepted: 01/26/2016] [Indexed: 12/22/2022] Open
Abstract
AIMS The aim of this study was to analyse randomized controlled study and real-world outcomes of patients with non-valvular atrial fibrillation (NVAF) undergoing left atrial appendage closure (LAAC) with the Watchman device and to compare costs with available antithrombotic therapies. METHODS AND RESULTS Registry data of LAAC from two centres were prospectively collected from 110 patients with NVAF at risk of stroke, suitable and unsuitable for long-term anticoagulation (age 71.3 ± 9.2 years, CHADS2 2.8 ± 1.2, CHA2DS2-VASc 4.5 ± 1.6, and HAS-BLED 3.8 ± 1.1). Outcomes from PROTECT AF and registry study LAAC were compared with warfarin, dabigatran, rivaroxaban, apixaban, aspirin, and no treatment using a network meta-analysis. Costs were estimated over a 10-year horizon. Uncertainty was assessed using sensitivity analyses. The procedural success rate was 92% (103/112). Follow-up was 24.1 ± 4.6 months, during which annual rates of stroke, major bleeding, and all-cause mortality were 0.9% (2/223 patient-years), 0.9% (2/223 patient-years), and 1.8% (4/223 patient-years), respectively. Anticoagulant therapy was successfully stopped in 91.2% (93/102) of implanted patients by 12 months. Registry study LAAC stroke and major bleeding rates were significantly lower than PROTECT AF results: mean absolute difference of stroke, 0.89% (P = 0.02) and major bleeding, 5.48% (P < 0.001). Left atrial appendage closure achieved cost parity between 4.9 years vs. dabigatran 110 mg and 8.4 years vs. warfarin. At 10 years, LAAC was cost-saving against all therapies (range £1162-£7194). CONCLUSION Left atrial appendage closure in NVAF in a real-world setting may result in lower stroke and major bleeding rates than reported in LAAC clinical trials. Left atrial appendage closure in both settings achieves cost parity in a relatively short period of time and may offer substantial savings compared with current therapies. Savings are most pronounced among higher risk patients and those unsuitable for anticoagulation.
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Affiliation(s)
- Sandeep Panikker
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Joanne Lord
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Julian W E Jarman
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | | | - David G Jones
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Shouvik Haldar
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Charles Butcher
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Habib Khan
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Lilian Mantziari
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Edward Nicol
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Wajid Hussain
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Jonathan R Clague
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - John P Foran
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Vias Markides
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Tom Wong
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
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Evans J, Silberbauer J, Glover B, Kontogeorgis A, McLellan A, Panikker S, Sieniewicz B, Martin C, Burg M, Providencia R, Behar J, Burke M, Withers K, White J, Lencioni M, Carolan-Rees G, Wood K, Patrick H, Griffith M, Gomes J, Kirubakaran S, O'Nunain S, Bencat M, McCready J, Michael K, Hashemi J, Gupta D, Akl S, Redfearn D, Lim E, Panikker S, Butcher C, Khan H, Mantziari L, Jarman J, Hussain W, Jones D, Clague J, Ernst S, Markides V, Wong T, Ezzat V, Schilling R, Lowe M, Whitaker J, Virmani R, Kutys R, Jarman J, Fastl T, Haldar S, Butcher C, Khan H, Mantziari L, O'Neill M, Corado C, Nicol E, Foran J, Markides V, Niederer S, Wong T, Behar J, Sohal M, Jais P, Derval N, Spragg D, Van Gelder B, Bracke F, Steendijk P, Rinaldi C, Chooneea B, Gajendragadkar P, Ahsan S, Begley D, Dhinoja M, Earley M, Ezzat V, Finlay M, Grace A, Heck P, Hunter R, Lambiase P, Lowe M, Rowland E, Schilling R, Segal O, Sporton S, Virdee M, Chow A, Apap Bologna R, Camilleri W, Sammut M, Aquilina O, Barra S, Papageorgiou N, Falconer D, Duehmke R, Rehal O, Ahsan S, Ezzat V, Dhinoja M, Ioannou A, Segal O, Sporton S, Rowland E, Lowe M, Lambiase P, Agarwal S, Chow A, Toth D, Mountney P, Reiml S, Panayioutu M, Brost A, Fahn B, Sohal M, Patel N, Claridge S, Jackson T, Adhya S, Sieniwicz B, O'Neill M, Razavi R, Rhode K, Rinaldi C, Tjong F, Brouwer T, Koop B, Soltis B, Shuros A, Knops R. ORAL ABSTRACTS (2)EP & Ablation19CARDIAC ABLATION PATIENT REPORTED OUTCOMES MEASURES (PROMS): ANALYSIS OF POST-ABLATION AND 1 YEAR FOLLOW-UP DATA20INTENTIONAL CORONARY VEIN EXIT AND CARBON DIOXIDE INSUFFLATION TO ALLOW SAFE SUBXIPHOID EPICARDIAL ACCESS FOR VENTRICULAR MAPPING AND ABLATION - FIRST EXPERIENCE21PACED FRACTIONATION DETECTION AS A TOOL FOR MAPPING SCARS IN VT22DOES USE OF CONTACT-FORCE SENSING CATHETERS IMPROVE THE OUTCOME OF ABLATION OF VENTRICULAR TACHYCARDIA?23RETROGRADE AORTIC ACCESS OF THE PULMONARY VENOUS ATRIUM PROVIDES EQUIVALENT OUTCOMES TO RIGHT ATRIAL OR TRANSEPTAL ACCESS OF THE LEFT ATRIUM IN PATIENTS WITH CONGENITAL HEART DISEASE24COMPUTATIONAL THREE-DIMENSION LEFT ATRIAL APPENDAGE WALL THICKNESS MAPS AND HISTOLOGICAL ANALYSIS TO GUIDE LEFT ATRIAL APPENDAGE ELECTRICAL ISOLATIONPacing & Devices25IDENTIFYING THE OPTIMAL LOCATION FOR LV ENDOCARIDAL PACING:RESULTS FROM A MULTICENTRE INTERNATIONAL REGISTRY OF LV ENDOCARDIAL PACING26UK MULTI-CENTRE REGISTRY OF TRANSVENOUS LEAD EXTRACTION: CLINICAL OUTCOME USING TRACTION, CUTTING SHEATHS AND LASER TECHNIQUES27SKIN FISTULA FORMATION - A NEW EXPERIENCE WITH THE NEW TYRX ABSORBABLE ANTIMICROVIAL ENVELOPE28BIFOCAL RIGHT VENTRICULAR PACING IN PATIENTS WITH FAILED CORONARY-SINUS LEAD IMPLANTS: LONG-TERM RESULTS FROM MULTICENTRE REGISTRY29REAL TIME X-MRI GUIDED LEFT VENTRICULAR LEAD IMPLANTATION FOR TARGETED DELIVERY OF CARDIAC RESYNCHRONIZATION THERAPY30ACUTE AND CHRONIC PERFORMANCE OF COMMUNICATING LEADLESS ANTI-TACHYCARDIA PACEMAKER AND SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR. Europace 2016. [DOI: 10.1093/europace/euw271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Panikker S, Jarman JW, Virmani R, Kutys R, Haldar S, Lim E, Butcher C, Khan H, Mantziari L, Nicol E, Foran JP, Markides V, Wong T. Response by Panikker et al to Letter Regarding Article, “Left Atrial Appendage Electrical Isolation and Concomitant Device Occlusion to Treat Persistent Atrial Fibrillation: A First-in-Human Safety, Feasibility, and Efficacy Study”. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004652. [DOI: 10.1161/circep.116.004652] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sandeep Panikker
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit Royal Brompton & Harefield Hospitals and National Heart and Lung Institute Imperial College London United Kingdom
| | - Julian W.E. Jarman
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit Royal Brompton & Harefield Hospitals and National Heart and Lung Institute Imperial College London United Kingdom
| | | | | | - Shouvik Haldar
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit Royal Brompton & Harefield Hospitals and National Heart and Lung Institute Imperial College London United Kingdom
| | - Eric Lim
- Department of Cardiac Electrophysiology National Heart Centre Singapore
| | - Charles Butcher
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College London United Kingdom
| | - Habib Khan
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College London United Kingdom
| | - Lilian Mantziari
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College London United Kingdom
| | - Edward Nicol
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College London United Kingdom
| | - John P. Foran
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College London United Kingdom
| | - Vias Markides
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College London United Kingdom
| | - Tom Wong
- Heart Rhythm Centre, NIHR Cardiovascular Research Unit Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College London United Kingdom
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Panikker S, Jarman JW, Virmani R, Kutys R, Haldar S, Lim E, Butcher C, Khan H, Mantziari L, Nicol E, Foran JP, Markides V, Wong T. Left Atrial Appendage Electrical Isolation and Concomitant Device Occlusion to Treat Persistent Atrial Fibrillation. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.003710. [DOI: 10.1161/circep.115.003710] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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: 10/05/2015] [Accepted: 05/12/2016] [Indexed: 12/21/2022]
Abstract
Background—
Left atrial appendage (LAA) electric isolation is reported to improve persistent atrial fibrillation (AF) ablation outcomes. However, loss of LAA mechanical function may increase thromboembolic risk. Concomitant LAA electric isolation and occlusion as part of conventional AF ablation has never been tested in humans. We therefore evaluated the feasibility, safety, and efficacy of LAA electric isolation and occlusion in patients undergoing long-standing persistent AF ablation.
Methods and Results—
Patients with long-standing persistent AF (age, 68±7 years; left atrium diameter, 46±3 mm; and AF duration, 25±15 months) underwent AF ablation, LAA electric isolation, and occlusion. Outcomes were compared with a balanced (1:2 ratio) control group who had AF ablation alone. Among 22 patients who underwent ablation, LAA electric isolation was possible in 20. Intraprocedural LAA reconnection occurred in 17 of 20 (85%) patients, predominantly at anterior and superior locations. All were reisolated. LAA occlusion was successful in all 20 patients. There were no major periprocedural complications. Imaging at 45 days and 9 months confirmed satisfactory device position and excluded pericardial effusion. One of twenty (5%) patients had a gap of ≥5 mm requiring anticoagulation. Nineteen of twenty (95%) patients stopped warfarin at 3 months. Without antiarrhythmic drugs, freedom from AF at 12 months after a single procedure was significantly higher in the study group (19/20, 95%) than in the control group (25/40, 63%),
P
=0.036. Freedom from atrial arrhythmias was demonstrated in 12 of 20 (60%) and 18 of 20 (90%) patients after 1 and ≤2 procedures (mean, 1.3), respectively.
Conclusions—
Persistent AF ablation, LAA electric isolation, and mechanical occlusion can be performed concomitantly. This technique may improve the success of persistent AF ablation while obviating the need for chronic anticoagulation.
Clinical Trial Registration—
URL:
https://clinicaltrials.gov
. Unique identifier: NCT02028130.
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Affiliation(s)
- Sandeep Panikker
- From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)
| | - Julian W.E. Jarman
- From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)
| | - Renu Virmani
- From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)
| | - Robert Kutys
- From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)
| | - Shouvik Haldar
- From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)
| | - Eric Lim
- From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)
| | - Charles Butcher
- From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)
| | - Habib Khan
- From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)
| | - Lilian Mantziari
- From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)
| | - Edward Nicol
- From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)
| | - John P. Foran
- From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)
| | - Vias Markides
- From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)
| | - Tom Wong
- From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)
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Panikker S, Lord J, Jarman J, Jones D, Haldar S, Butcher C, Khan H, Mantziari L, Nicol E, Hussain W, Clague J, Foran J, Markides V, Wong T. 17-05: Health Economic Analysis of Left Atrial Appendage Closure from Randomised Controlled Trial and Real-World Experience Relative to Oral Anticoagulation by CHA2DS2-VASc sub-group. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i162a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Panikker S, Whitaker J, Virmani R, Kutys R, Jarman J, Fastl T, Haldar S, Butcher C, Khan H, Mantziari L, O'Neill M, Corrado C, Nicol E, Foran J, Markides V, Niederer S, Wong T. 229-06: Left Atrial Appendage Electrical Isolation for Long-Standing Persistent Atrial Fibrillation: Computational Three-Dimensional Left Atrial Appendage Wall Thickness Maps and Histological Analysis to Guide Ablation. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i160c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Mantziari L, Butcher C, Kontogeorgis A, Panikker S, Roy K, Markides V, Wong T. Utility of a Novel Rapid High-Resolution Mapping System in the Catheter Ablation of Arrhythmias. JACC Clin Electrophysiol 2015; 1:411-420. [DOI: 10.1016/j.jacep.2015.06.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/11/2015] [Accepted: 06/17/2015] [Indexed: 11/28/2022]
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17
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Dakos G, Konstantinou D, Chatzizisis YS, Chouvarda I, Filos D, Paraskevaidis S, Mantziari L, Maglaveras N, Karvounis H, Vassilikos V. P wave analysis with wavelets identifies hypertensive patients at risk of recurrence of atrial fibrillation: A case–control study and 1year follow-up. J Electrocardiol 2015. [DOI: 10.1016/j.jelectrocard.2015.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Ventoulis I, Mantziari L, Mouratoglou SA, Kamperidis V, Giannakoulas G, Ziakas A, Tsalikakis D, Giamouzis G, Hitoglou-Makedou A, Karvounis H. NGAL and ST2 levels in ambulatory patients with chronic heart failure. Clinical and echocardiographic correlates. SCAND CARDIOVASC J 2015; 49:213-9. [PMID: 25919009 DOI: 10.3109/14017431.2015.1043141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 11/13/2022]
Abstract
AIM Neutrophil gelatinase-associated lipocalin (NGAL) and ST2 receptor, a member of the interleukin-1 receptor family, are novel biomarkers with a potential role in the diagnosis and risk stratification of patients with chronic heart failure (CHF). There is however scarce data on their relation with clinical characteristics and cardiac function in patients with CHF. METHODS Consecutive ambulatory patients with CHF were studied. All patients underwent clinical and echocardiographic assessment, and blood samples were collected for the estimation of ST2 and NGAL serum levels during the same assessment. RESULTS A total of 76 patients (79% male, mean age: 63 ± 14 years), with CHF and left ventricular ejection fraction of 28 ± 7% were included. Median NGAL was 0.16 (0.09-0.275) mg/L and median ST2 was 0.0125 (0.0071-0.0176) mg/L. No association between NGAL and ST2 was observed. Multivariate analysis revealed tissue Doppler-derived right ventricular systolic velocity as an independent predictor of ST2, and the duration of HF and serum creatinine levels as independent predictors of NGAL. CONCLUSIONS NGAL levels depend on the renal function and the duration of HF, while ST2 levels are affected by the right but not the left ventricular function and show no association with clinical indices of HF.
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Affiliation(s)
- Ioannis Ventoulis
- 1st Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
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19
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Ernst S, Saenen J, Rydman R, Gomez F, Roy K, Mantziari L, Suman-Horduna I. Utility of noninvasive arrhythmia mapping in patients with adult congenital heart disease. Card Electrophysiol Clin 2015; 7:117-123. [PMID: 25784028 DOI: 10.1016/j.ccep.2014.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Arrhythmia management in patients with adult congenital heart disease (ACHD) is a challenge on many levels, as tachycardic episodes may lead to hemodynamic impairment in otherwise compensated patients even if episodes are only transient. Recently several technical advances, including 3-dimensional (3D) image integration, 3D mapping, and remote magnetic navigation, have been introduced to facilitate curatively intended ablation procedures in patients with ACHD. This review attempts to outline the role of a novel technology of simultaneous, noninvasive mapping in this patient cohort, and gives details of the authors' single-center experience.
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Affiliation(s)
- Sabine Ernst
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield Hospital, National Heart and Lung Institute, Imperial College London, Sydney Street, London SW3 6NP, UK.
| | - Johan Saenen
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Riikka Rydman
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Federico Gomez
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Karine Roy
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Lilian Mantziari
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Irina Suman-Horduna
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
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20
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Dakos G, Chatzizisis YS, Konstantinou D, Chouvarda I, Filos D, Paraskevaidis S, Mantziari L, Maglaveras N, Karvounis H, Styliadis I, Vassilikos V. Wavelet-based analysis of P waves identifies patients with lone atrial fibrillation: A cross-sectional pilot study. Int J Cardiol 2014; 174:389-92. [PMID: 24767760 DOI: 10.1016/j.ijcard.2014.03.195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 02/20/2014] [Accepted: 03/31/2014] [Indexed: 11/17/2022]
Affiliation(s)
- George Dakos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece.
| | - Yiannis S Chatzizisis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Dimitrios Konstantinou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Ioanna Chouvarda
- Laboratory of Medical Informatics, Aristotle University Medical School, Thessaloniki, Greece
| | - Dimitrios Filos
- Laboratory of Medical Informatics, Aristotle University Medical School, Thessaloniki, Greece
| | - Stylianos Paraskevaidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Lilian Mantziari
- First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece; Department of Cardiology, Electrophysiology Unit, Royal Brompton Hospital, London, UK
| | - Nicos Maglaveras
- Laboratory of Medical Informatics, Aristotle University Medical School, Thessaloniki, Greece
| | - Haralambos Karvounis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Ioannis Styliadis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Vassilios Vassilikos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece; Third Department of Cardiology, Hippokrateion University Hospital, Aristotle University Medical School, Thessaloniki, Greece
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21
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Honarbakhsh S, Suman-Horduna I, Mantziari L, Ernst S. Arrhythmogenic Right Ventricle in Left Ventricular Non-compaction - In Response to the Letter to the Editor "Diagnostic Dilemmas for Underlying Pathophysiology of Arrhythmias Originating from the Right Ventricle". Indian Pacing Electrophysiol J 2014; 14:103-4. [PMID: 24669112 PMCID: PMC3952614 DOI: 10.1016/s0972-6292(16)30739-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Lilian Mantziari
- Royal Brompton and Harefield NHS Foundation Trust, United Kingdom
| | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, United Kingdom ; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London
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22
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Honarbakhsh S, Suman-Horduna I, Mantziari L, Ernst S. Arrhythmogenic Right Ventricle in Left Ventricular Non-compaction - In response to "Right Ventricular Ablation as a Therapeutic Option for Left Ventricular Hypertrabeculation / noncompaction". Indian Pacing Electrophysiol J 2014; 14:105-7. [PMID: 24669113 PMCID: PMC3952617 DOI: 10.1016/s0972-6292(16)30740-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | - Lilian Mantziari
- Royal Brompton and Harefield NHS Foundation Trust, United Kingdom
| | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, United Kingdom ; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London
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23
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Triposkiadis FK, Butler J, Karayannis G, Starling RC, Filippatos G, Wolski K, Parissis J, Parisis C, Rovithis D, Koutrakis K, Skoularigis J, Antoniou CK, Chrysohoou C, Pitsavos C, Stefanadis C, Nastas J, Tsaknakis T, Mantziari L, Giannakoulas G, Karvounis H, Kalogeropoulos AP, Giamouzis G. Efficacy and safety of high dose versus low dose furosemide with or without dopamine infusion: the Dopamine in Acute Decompensated Heart Failure II (DAD-HF II) trial. Int J Cardiol 2014; 172:115-21. [PMID: 24485633 DOI: 10.1016/j.ijcard.2013.12.276] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [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: 11/15/2013] [Accepted: 12/29/2013] [Indexed: 01/11/2023]
Abstract
AIMS The role of low-dose dopamine infusion in patients with acute decompensated heart failure (ADHF) remains controversial. We aim to evaluate the efficacy and safety of high- versus low-dose furosemide with or without low-dose dopamine infusion in this patient population. METHODS AND RESULTS 161 ADHF patients (78 years; 46% female; ejection fraction 31%) were randomized to 8-hour continuous infusions of: a) high-dose furosemide (HDF, n=50, 20mg/h), b) low-dose furosemide and low-dose dopamine (LDFD, n=56, 5mg/h and 5 μg kg(-1)min(-1) respectively), or c) low-dose furosemide (LDF, n=55, furosemide 5mg/h). The main outcomes were 60-day and one-year all-cause mortality (ACM) and hospitalization for HF (HHF). Dyspnea relief (Borg index), worsening renal function (WRF, rise in serum creatinine (sCr) ≥ 0.3mg/dL), and length of stay (LOS) were also assessed. The urinary output at 2, 4, 6, 8, and 24h was not significantly different in the three groups. Neither the ACM at day 60 (4.0%, 7.1%, and 7.2%; P=0.74) or at one year (38.1%, 33.9% and 32.7%, P=0.84) nor the HHF at day 60 (22.0%, 21.4%, and 14.5%, P=0.55) or one year (60.0%, 50.0%, and 47%, P=0.40) differed between HDF, LDFD, and LDF groups, respectively. No differences in the Borg index or LOS were noted. WRF was higher in the HDF than in LDFD and LDF groups at day 1 (24% vs. 11% vs. 7%, P<0.0001) but not at sCr peak (44% vs. 38% vs. 29%, P=0.27). No significant differences in adverse events were noted. CONCLUSIONS In ADHF patients, there were no significant differences in the in-hospital and post-discharge outcomes between high- vs. low-dose furosemide infusion; the addition of low-dose dopamine infusion was not associated with any beneficial effects.
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Affiliation(s)
- Filippos K Triposkiadis
- Department of Cardiology, Larissa University Hospital, Medical School, University of Thessaly, Larissa, Greece
| | - Javed Butler
- Cardiology Division, Emory University, Atlanta, GA, USA
| | - Georgios Karayannis
- Department of Cardiology, Larissa University Hospital, Medical School, University of Thessaly, Larissa, Greece
| | - Randall C Starling
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Gerasimos Filippatos
- Department of Cardiology, "Attikon" University Hospital, Medical School, University of Athens, Athens, Greece
| | - Kathy Wolski
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - John Parissis
- Department of Cardiology, "Attikon" University Hospital, Medical School, University of Athens, Athens, Greece
| | - Charalabos Parisis
- Department of Cardiology, Larissa University Hospital, Medical School, University of Thessaly, Larissa, Greece
| | - Dimitrios Rovithis
- Department of Cardiology, Larissa University Hospital, Medical School, University of Thessaly, Larissa, Greece
| | - Konstantinos Koutrakis
- Department of Cardiology, Larissa University Hospital, Medical School, University of Thessaly, Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, Larissa University Hospital, Medical School, University of Thessaly, Larissa, Greece
| | | | - Christina Chrysohoou
- First Cardiology Clinic, Hippokration Hospital, Medical School, University of Athens, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Hippokration Hospital, Medical School, University of Athens, Athens, Greece
| | - Christodoulos Stefanadis
- First Cardiology Clinic, Hippokration Hospital, Medical School, University of Athens, Athens, Greece
| | - John Nastas
- Department of Cardiology, Volos General Hospital, Volos, Greece
| | | | - Lilian Mantziari
- First Cardiology Department, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Giannakoulas
- First Cardiology Department, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haralambos Karvounis
- First Cardiology Department, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Gregory Giamouzis
- Department of Cardiology, Larissa University Hospital, Medical School, University of Thessaly, Larissa, Greece.
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24
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Theron P, Guha K, Mantziari L, Salahuddin S, Sharma R, Jaggar S. General anesthesia versus sedation for implantation of a biventricular pacing device for cardiac resynchronization therapy. J Cardiothorac Vasc Anesth 2013; 28:280-4. [PMID: 24295721 DOI: 10.1053/j.jvca.2013.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Heart failure carries significant risk for major noncardiac surgery. Whether this risk is transferable to minor surgery is less well-documented. Thus, the aim of this study was to assess the outcome of a contemporary cohort of heart failure patients undergoing cardiac resynchronization therapy (CRT) device insertion under general anesthesia or sedation. DESIGN Retrospective observational study. SETTING Tertiary cardiac specialist hospital. PARTICIPANTS Heart failure patients. INTERVENTIONS CRT insertion under general anesthesia or sedation. MEASUREMENTS AND MAIN RESULTS Anesthesia, heart failure, and outcome data were collected on a consecutive series of patients having CRT device insertion between 2002 and 2010. A total of 242 patients were managed by the anesthesia department during the study period. After exclusion criteria were applied, data for 183 patients were analyzed. Immediate perioperative (<24 hours) mortality was zero; 30-day mortality of 138 patients was 2.2%. One patient (0.5%) required unplanned intensive care admission. A comparison was made between the sedation (n = 76) group and the general anesthesia (GA) group (n = 107). When compared with the sedation group, the GA group had more intraoperative hypotension (26.2% versus 4.0%, p<0.00001). There was no difference between the GA and sedation groups with regard to 30-day mortality (1.4% versus 3.1%, p = 0.57), unplanned intensive care admission (0% versus 1.3%, p = 0.42), and length of stay in days (3 versus 3, p = 0.82). CONCLUSION The authors found that patients with heart failure undergoing CRT insertion with concurrent general anesthesia or sedation had minimal immediate perioperative risk and that there was no difference in postoperative outcome between general anesthesia and sedation.
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Affiliation(s)
- Paul Theron
- Department of Anesthesia, Royal Brompton Hospital, London, United Kingdom.
| | - Kaushik Guha
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Lilian Mantziari
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Salman Salahuddin
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Rakesh Sharma
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Sian Jaggar
- Department of Anesthesia, Royal Brompton Hospital, London, United Kingdom
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Mantziari L, Vassilikos V, Anastasakis A, Kotsaka X, Paraskevaidis S, Styliadis IH, Luria D. A de novo novel cardiac ryanodine mutation (Ser4155Tyr) associated with catecholaminergic polymorphic ventricular tachycardia. Ann Noninvasive Electrocardiol 2013; 18:571-6. [PMID: 24147812 DOI: 10.1111/anec.12089] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We describe the case of a 14-year-old girl with a history of syncopal episodes triggered by stress or exercise. Catecholaminergic polymorphic ventricular tachycardia was diagnosed with the aid of an implantable loop recorder. The genetic testing of the patient and her family revealed a de novo novel missense mutation (Ser4155Tyr) in the exon 90 of the ryanodine receptor gene. This mutation affects a highly conserved residue (S4155) and results to replacement of serine (S) with tyrosine (Y) leading to change in physical and chemical properties. The girl was treated with an implantable defibrillator, metoprolol and flecainide. Over 1 year of follow-up she had no recurrence of ventricular tachycardia.
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Affiliation(s)
- Lilian Mantziari
- First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece; Royal Brompton Hospital and Harefield NHS Trust, London, United Kingdom
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Honarbakhsh S, Suman-Horduna I, Mantziari L, Ernst S. Successful Right Ventricular Tachycardia Ablation in a Patient with Left Ventricular Non-compaction Cardiomyopathy. Indian Pacing Electrophysiol J 2013; 13:181-4. [PMID: 24130428 PMCID: PMC3775322 DOI: 10.1016/s0972-6292(16)30671-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
We report a case of a 67-year old male with a recent diagnosis of left ventricular non-compaction (LVNC), initially presenting with symptomatic ventricular ectopy and runs of non-sustained ventricular tachycardia (VT). This ventricular arrhythmia originated in a structurally normal right ventricle (RV) and was successfully localized and ablated with the aid of the three-dimensional mapping and remote magnetic navigation.
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Mantziari L, Ueda A, Suman-Horduna I, Ho SY, Babu-Narayan S, Ernst S. Radiofrequency ablation of supraventricular tachycardias in patients with congenital heart disease and difficult access to the chamber of interest using remote magnetic navigation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4922] [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: 11/13/2022] Open
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Suman Horduna I, Mantziari L, Ernst S. Use of panoramic body surface electrocardiographic for mapping of tachyarrhythmias in adult patients with congenital heart disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5598] [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: 11/15/2022] Open
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Ernst S, Pedersen M, Uebing A, Suman-Horduna I, Mantziari L, Li W, Babu-Narayan SV. Successful ablation of two right atrial tachycardias on either side of the lateral tunnel patch in a patient with double inlet left ventricle and total cavopulmonary connection: Two sites and two mechanisms. Glob Cardiol Sci Pract 2013; 2013:198-202. [PMID: 24689020 PMCID: PMC3963736 DOI: 10.5339/gcsp.2013.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 04/22/2013] [Indexed: 11/05/2022] Open
Affiliation(s)
| | | | - Anselm Uebing
- Department of Adult Congenital Heart Disease, Royal Brompton Hospital, London, UK
| | | | | | - Wei Li
- Department of Adult Congenital Heart Disease, Royal Brompton Hospital, London, UK
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Ueda A, Suman-Horduna I, Mantziari L, Gujic M, Marchese P, Ho SY, Babu-Narayan SV, Ernst S. Contemporary Outcomes of Supraventricular Tachycardia Ablation in Congenital Heart Disease. Circ Arrhythm Electrophysiol 2013; 6:606-13. [DOI: 10.1161/circep.113.000415] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Akiko Ueda
- From the Cardiac Morphology Unit, Department of Pediatrics (A.U., S.Y.H.), and Department of Cardiology (I.S.-H., L.M., M.G., P.M., S.V.B.-N., S.E.), Royal Brompton Hospital, London, United Kingdom; and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.V.B.-N., S.E.)
| | - Irina Suman-Horduna
- From the Cardiac Morphology Unit, Department of Pediatrics (A.U., S.Y.H.), and Department of Cardiology (I.S.-H., L.M., M.G., P.M., S.V.B.-N., S.E.), Royal Brompton Hospital, London, United Kingdom; and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.V.B.-N., S.E.)
| | - Lilian Mantziari
- From the Cardiac Morphology Unit, Department of Pediatrics (A.U., S.Y.H.), and Department of Cardiology (I.S.-H., L.M., M.G., P.M., S.V.B.-N., S.E.), Royal Brompton Hospital, London, United Kingdom; and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.V.B.-N., S.E.)
| | - Marko Gujic
- From the Cardiac Morphology Unit, Department of Pediatrics (A.U., S.Y.H.), and Department of Cardiology (I.S.-H., L.M., M.G., P.M., S.V.B.-N., S.E.), Royal Brompton Hospital, London, United Kingdom; and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.V.B.-N., S.E.)
| | - Procolo Marchese
- From the Cardiac Morphology Unit, Department of Pediatrics (A.U., S.Y.H.), and Department of Cardiology (I.S.-H., L.M., M.G., P.M., S.V.B.-N., S.E.), Royal Brompton Hospital, London, United Kingdom; and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.V.B.-N., S.E.)
| | - Siew Yen Ho
- From the Cardiac Morphology Unit, Department of Pediatrics (A.U., S.Y.H.), and Department of Cardiology (I.S.-H., L.M., M.G., P.M., S.V.B.-N., S.E.), Royal Brompton Hospital, London, United Kingdom; and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.V.B.-N., S.E.)
| | - Sonya V. Babu-Narayan
- From the Cardiac Morphology Unit, Department of Pediatrics (A.U., S.Y.H.), and Department of Cardiology (I.S.-H., L.M., M.G., P.M., S.V.B.-N., S.E.), Royal Brompton Hospital, London, United Kingdom; and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.V.B.-N., S.E.)
| | - Sabine Ernst
- From the Cardiac Morphology Unit, Department of Pediatrics (A.U., S.Y.H.), and Department of Cardiology (I.S.-H., L.M., M.G., P.M., S.V.B.-N., S.E.), Royal Brompton Hospital, London, United Kingdom; and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.V.B.-N., S.E.)
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Suman-Horduna I, Babu-Narayan SV, Ueda A, Mantziari L, Gujic M, Marchese P, Dimopoulos K, Gatzoulis MA, Rigby ML, Ho SY, Ernst S. Magnetic navigation in adults with atrial isomerism (heterotaxy syndrome) and supraventricular arrhythmias. Europace 2013; 15:877-85. [PMID: 23355132 DOI: 10.1093/europace/eus384] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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] [Indexed: 11/08/2023] Open
Abstract
AIMS We analysed the type and mechanism of supraventricular arrhythmias encountered in a series of symptomatic adults with atrial isomerism undergoing catheter ablation procedures. METHODS AND RESULTS The study population included consecutive adults with atrial isomerism who had previously undergone surgical repair or palliation of the associated anomalies. Patients underwent electrophysiological study for symptomatic arrhythmia in our institution between 2010 and 2012 using magnetic navigation in conjunction with CARTO RMT and three-dimensional (3D) image integration. Eight patients (five females) with a median age of 33 years [interquartile range (IQR) 24-39] were studied. Access to the cardiac chambers of interest was obtained retrogradely via the aorta using remotely navigated magnetic catheters in six patients. Radiofrequency ablation successfully targeted twin atrioventricular (AV) nodal reentrant tachycardia in two patients, atrial fibrillation (AF) in three, focal atrial tachycardia (AT) mainly originating in the left-sided atrium in four patients, and macro-reentrant AT dependent on a right-sided inferior isthmus in three patients. The median fluoroscopy time was 3.0 min (IQR 2-11). After a median follow-up of 10 months (IQR 6-21), five of the ablated patients are free from arrhythmia; two patients experienced episodes of self-terminated AF and AT, respectively, within one month post-ablation; the remaining patient had only non-sustained AT during the electrophysiological study and was managed medically. CONCLUSION Various supraventricular tachycardia mechanisms are possible in adults with heterotaxy syndrome, all potentially amenable to radiofrequency ablation. The use of remote magnetic navigation along with 3D mapping facilitated the procedures and resulted in a short radiation time.
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Affiliation(s)
- Irina Suman-Horduna
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, SW3 6NP, UK.
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Honarbakhsh S, Suman-Horduna I, Mantziari L, Ernst S. Grouped Beating in Eisenmenger: Successful Localization and Ablation of an Accelerated Idioventricular Rhythm from Within the Purkinje System. Indian Pacing Electrophysiol J 2013; 13:126-30. [PMID: 23840108 PMCID: PMC3691392 DOI: 10.1016/s0972-6292(16)30631-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Shohreh Honarbakhsh
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
| | - Irina Suman-Horduna
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
| | - Lilian Mantziari
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
| | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London (SE)
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Mantziari L, Rigby M, Till J, Ernst S. Accessory pathway ablation in a 6-year-old girl using remote magnetic navigation as an alternative to cryoablation. Pediatr Cardiol 2013; 34:760-3. [PMID: 23086190 DOI: 10.1007/s00246-012-0540-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 09/20/2012] [Indexed: 11/28/2022]
Abstract
A 6-year-old girl with evidence of a parahisian accessory pathway on a baseline electrocardiogram underwent successful catheter ablation using magnetic navigation. Magnetic remote controlled ablation eliminated the parahisian pathway with the first radiofrequency application. A second anterolaterally located concealed pathway was successfully ablated in the same session, resulting in exclusively atrioventricular nodal conduction bidirectionally (total fluoroscopy, 4 min; 25 μGy).
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Affiliation(s)
- Lilian Mantziari
- Cardiology Department, Royal Brompton and Harefield Hospital, London, UK.
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Filos D, Chouvarda I, Dakos G, Mantziari L, Vassilikos V, Maglaveras N. Wavelet variability of SA node originated P waves in atrial fibrillation and in signals with ectopic beats. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2012:6369-72. [PMID: 23367386 DOI: 10.1109/embc.2012.6347451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Atrial fibrillation (AF) is one of the most common cardiac arrhythmia. Electrical properties of the atrial myocardium may be related to the appearance of this type of arrhythmia. However ectopic beats, occurring normally in healthy people, disturb cardiac rhythm. Those beats arise from fiber outside the region of SA node. With this work we aim at highlighting differences in the atrial activity between healthy subjects, healthy subjects presenting many ectopic events and patients with AF. The X-Y-Z leads of vectorcardiography recordings are considered. Wavelet-based parameters are extracted from a window which represents atrial activity originated from SA node and compared between signals of the three groups. Results show differences potentially related to the conduction system of the atrium between healthy people and people with AF, as well as between healthy people and people with ectopic events. No difference was found from the analysis of SA node beats between people with AF and healthy with ectopic events.
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Affiliation(s)
- D Filos
- Lab of Medical Informatics, Aristotle University of Thessaloniki, Greece.
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Mantziari L, Suman-Horduna I, Babu-Narayan SV, Ernst S. Advanced ablation strategies for management of post-surgical atrial arrhythmias. Glob Cardiol Sci Pract 2013; 2013:140-8. [PMID: 24689014 PMCID: PMC3963742 DOI: 10.5339/gcsp.2013.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 02/22/2013] [Indexed: 11/05/2022] Open
Abstract
Post-surgical arrhythmias include a wide range of arrhythmias occurring late after cardiac surgery and represent a complex substrate for catheter ablation either because of extended scar and remodeling or because of limited access to the area of interest. Novel image integration and ablation tools have made the catheter ablation in this population both feasible and successful. We review a structured approach to catheter ablation of post-surgical atrial arrhythmias in various patient cohorts including the most common congenital heart defects.
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Affiliation(s)
- Lilian Mantziari
- Cardiology Department, Royal Brompton and Harefield Hospital, London, UK
| | | | | | - Sabine Ernst
- Cardiology Department, Royal Brompton and Harefield Hospital, London, UK
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Mantziari L, Kamperidis V, Ventoulis I, Damvopoulou E, Giannakoulas G, Efthimiadis G, Paraskevaidis S, Vassilikos V, Ziakas A, Karvounis H, Styliadis IH. Increased right atrial volume index predicts low Duke activity status index in patients with chronic heart failure. Hellenic J Cardiol 2013; 54:32-38. [PMID: 23340127] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION The aim of the present study was to examine the value of the right atrial volume index (RAVI) as predictor of functional capacity in patients with heart failure. METHODS A total of 51 patients with stable chronic heart failure of ischaemic or non-ischaemic aetiology were prospectively enrolled. The systolic function of the right ventricle was quantified using the tricuspid annular plane systolic excursion (TAPSE). Right atrial volume was measured in the apical 4-chamber view and was indexed to body surface area. The functional capacity was assessed by the Duke Activity Status Index (DASI). RESULTS Patients with a low functional capacity (DASI<10) had lower TAPSE (1.4 ± 0.3 cm versus 2.0 ± 0.4 cm, p<0.001), higher RAVI (42 ± 15 ml/m(2) versus 22 ± 9 ml/m(2), p<0.001), higher estimated right ventricular systolic pressure (61 ± 13 mmHg versus 40 ± 16 mmHg, p<0.001), larger right ventricular end-diastolic diameter (4.7 ± 0.8 cm versus 3.6 ± 0.7 cm, p<0.001) and lower left ventricular ejection fraction (26 ± 6% versus 30 ± 7%, p=0.022). Multivariate analysis revealed that TAPSE was the single independent predictor of DASI. In the subgroup of patients with reduced right ventricular systolic function (TAPSE<2 cm), RAVI was the single independent predictor of low DASI. In the overall population RAVI=30.6 ml/m(2) had 75% sensitivity and 83% specificity in predicting DASI<10. Within the subgroup of patients with TAPSE<2 cm, RAVI=30.6 ml/m(2) had better sensitivity and specificity (79% and 90% respectively) in predicting DASI<10. CONCLUSIONS Increased right atrial volume index predicts low functional capacity quantified by the Duke Activity Status Index in patients with stable chronic heart failure.
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Affiliation(s)
- Lilian Mantziari
- First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece.
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Parissis JT, Mantziari L, Kaldoglou N, Ikonomidis I, Nikolaou M, Mebazaa A, Altenberger J, Delgado J, Vilas-Boas F, Paraskevaidis I, Anastasiou-Nana M, Follath F. Gender-related differences in patients with acute heart failure: management and predictors of in-hospital mortality. Int J Cardiol 2012; 168:185-9. [PMID: 23041090 DOI: 10.1016/j.ijcard.2012.09.096] [Citation(s) in RCA: 28] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 07/06/2012] [Accepted: 09/15/2012] [Indexed: 11/15/2022]
Abstract
AIM AND METHODS Gender-related differences in clinical phenotype, in-hospital management and prognosis of acute heart failure (AHF) patients have been previously reported in European and US registries. The ALARM-HF survey is the first to include a cohort of 4953 patients hospitalized for AHF in 666 hospitals in 6 European countries, Mexico and Australia. RESULTS Women accounted for 37% of the study population, were older and had higher rates of de novo heart failure (45% vs 36%, p<0.001) than men. An acute coronary syndrome (ACS) was the predominant precipitating factor in both genders, but to a lesser extent in females (30% vs 42%, p<0.001). Between genders comparison showed higher incidence of atrial fibrillation, valvular heart disease, diabetes, obesity, anemia and depression in women (p<0.05). Similarly, women had higher left ventricular ejection fraction (LVEF) on admission (42 ± 15% vs 36 ± 13%, p<0.001) and systolic blood pressure (135 ± 40 mm Hg vs 131 ± 39 mm Hg, p=0.001) than men. On the other hand, men had more often coronary artery disease, renal failure and chronic obstructive pulmonary disease (p<0.05). Importantly, in-hospital mortality was similar in both genders (11.1% in females vs 10.5% in males, p=0.475), and its common predictors were: systolic blood pressure at admission, creatinine>1.5mg/dL and diabetes. Furthermore, recent ACS, valvular heart disease and dementia contributed to prognosis in women, while LVEF, hypertension and anemia were independent predictors in men. CONCLUSION Among patients with AHF, there are significant differences in co-morbidities, precipitating factors and predictors of in-hospital mortality between genders. Nevertheless, in-hospital mortality remains similar between genders.
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Affiliation(s)
- John T Parissis
- Second Cardiology Department, Attikon University Hospital, Athens, Greece.
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Mantziari L, Ziakas A, Ventoulis I, Kamperidis V, Lilis L, Katsiki N, Karavasiliadou S, Kiraklidis K, Pliakos C, Gemitzis K, Karvounis H, Styliadis IH. Differences in Clinical Presentation and Findings between Idiopathic Dilated and Ischaemic Cardiomyopathy in an Unselected Population of Heart Failure Patients. Open Cardiovasc Med J 2012; 6:98-105. [PMID: 23002403 PMCID: PMC3447189 DOI: 10.2174/1874192401206010098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 08/05/2012] [Indexed: 11/22/2022] Open
Abstract
We explored the differences in epidemiologic, clinical, laboratory and echocardiographic characteristics between idiopathic dilated (IDCM) and ischaemic cardiomyopathy (ICM). Consecutive patients with stable chronic heart failure evaluated at a tertiary cardiac centre were enrolled. Clinical examination, blood tests and echocardiographic study were performed. A total of 76 patients (43 IDCM, 33 ICM) were studied. IDCM patients were younger (p<0.001) and female gender was more prevalent (p=0.022). NYHA class and left ventricular ejection fraction were similar. IDCM patients had lower rates of dyslipidaemia (p<0.001) but smoked more than ICM patients (p=0.023) and had higher rates of family history of sudden cardiac death (p=0.048). Blood pressure was similar but resting heart rate was higher in IDCM patients (p=0.022). IDCM patients presented less frequently with peripheral oedema or ascites (p=0.046 and 0.020, respectively) and showed better right ventricular function on echocardiogram. QRS duration was similar between groups but only in IDCM patients there was a positive correlation between QRS duration and age (r=0.619, p<0.001). Cardiac output was similar but functional capacity assessed by the Duke Activity Status Index was better in IDCM (p=0.036). Despite these differences, IDCM and ICM patients received similar treatments. Patients with IDCM were younger, presented lower rates of right ventricular dysfunction and clinical right ventricular failure and had better functional capacity. Additional differences in clinical and laboratory findings exist pointing to a different patient population with diverse prognosis and potential need for individualized management.
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Affiliation(s)
- Lilian Mantziari
- First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
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Moralidis E, Mantziari L, Gerasimou G, Styliadis IH, Gotzamani-Psarrakou A. Somatostatin analogue scintigraphy in a patient with viral myocarditis. Hell J Nucl Med 2012; 15:144-6. [PMID: 22741149 DOI: 10.1967/s002449910031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 04/25/2012] [Indexed: 11/18/2022]
Abstract
Myocarditis may present clinically with a wide range of manifestations and often remains unrecognized. The diagnosis of myocarditis traditionally has been based on histological findings, but endomyocardial biopsy has a low sensitivity and clinicians are reluctant to proceed with an invasive diagnostic technique. Among newer diagnostic approaches, cardiac magnetic resonance imaging has gained acceptance as an efficient noninvasive tool to determine myocardial inflammation. In this context, imaging with radiolabeled somatostatin analogues could also be relevant because of their ability to delineate inflammatory sites. In conclusion, a case is presented in which somatostatin receptor imaging of the myocardium with (99m)Tc-depreotide tomography was used in the assessment of viral myocarditis.
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Affiliation(s)
- Efstratios Moralidis
- Department of Nuclear Medicine, AHEPA University Hospital, Thessaloniki, Greece.
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Vassilikos VP, Efremidis M, Mantziari L, Billis A, Theodorakis G, Katzivas A, Paraskevaidis S, Maounis T, Livanis E, Manolis A, Chatzinikolaou E, Defteraios S, Katritsis D, Kanoupakis E, Papagiannis I, Frangakis N, Gatzoulis K, Dagres N, Apostolopoulos T, Rokas S, Gaitanidou S, Chiladakis I, Kalpakos D, Sakadamis G, Kourgianidis G. Radiofrequency ablation procedures in Greece: initial experience and results from the national registry 2008-2010. Hellenic J Cardiol 2012; 53:108-117. [PMID: 22484776] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION In 2008 the radiofrequency ablation procedures (RFA) registry of the Hellenic Cardiological Society (HCS) was created. This is a dynamic, web-based application, which acts as the interface for storing and retrieving patients' demographic data and ablation procedures. Access to the site is permitted only to registered users. The purpose of this study is to report the results of RFA procedures performed in Greece over the 2008-2010 period. METHODS There are 27 centers in 24 hospitals that are licensed to perform RFA in Greece. During the period 2008-2010, 3541 RFA procedures were performed in 3344 patients in 23 centers. Four centers did not contribute data at all for various reasons. It is interesting that nearly 50% of the total number of procedures were performed at 3 high volume centers (>100 cases/year). RESULTS The most common procedure was slow pathway ablation for atrioventricular reentrant tachycardia, the second was ablation of accessory pathway related tachycardias, and the third was ablation of atrial fibrillation. Success rates were high (92.1%), the complication rate was 3% (serious complications <1%) and total relapse rate was 8.7% at six months' follow up. CONCLUSIONS The electronic RFA registry in Greece confirmed that all RFA procedures are performed in Greece with high success and low complication rates, comparable to the European and US standards. The experience and results from the first three-year period using the registry are very interesting and encouraging, thus indicating the need for development of similar databases at the national level.
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Affiliation(s)
- Vassilios P Vassilikos
- First Cardiology Division, AHEPA University Hospital, Medical School, University of Thessaloniki, Greece.
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Polymeropoulos K, Vassilikos VP, Mantziari L, Paraskevaidis S, Karamitsos TD, Mochlas S, Parcharidis G, Louridas G, Styliadis IH. Ibutilide for the Cardioversion of Paroxysmal Atrial Fibrillation during Radiofrequency Ablation of Supraventricular Tachycardias. Cardiol Res Pract 2011; 2011:270143. [PMID: 21738857 PMCID: PMC3123907 DOI: 10.4061/2011/270143] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 03/27/2011] [Indexed: 11/25/2022] Open
Abstract
Direct current electrical cardioversion (DC-ECV) is the preferred treatment for the termination of paroxysmal atrial fibrillation (AF) that occurs during radiofrequency ablation (RFA) of supraventricular tachycardias (SVT). Intravenous Ibutilide may be an alternative option in this setting. Thirty-four out of 386 patients who underwent SVT-RFA presented paroxysmal AF during the procedure and were randomized into receiving ibutilide or DC-ECV. Ibutilide infusion successfully cardioverted 16 out of 17 patients (94%) within 17.37 ± 7.87
min. DC-ECV was successful in all patients (100%) within 17.29 ± 3.04
min. Efficacy and total time to cardioversion did not differ between the study groups. No adverse events were observed. RFA was successfully performed in 16 patients (94%) in the ibutilide arm and in all patients (100%) in the DC-ECV arm, p = NS. In conclusion, ibutilide is a safe and effective alternative treatment for restoring sinus rhythm in cases of paroxysmal AF complicating SVT-RFA.
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Affiliation(s)
- Kostas Polymeropoulos
- First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece
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Mantziari L, Guha K, Senguttuvan NB, Sharma R. Cardiac resynchronization therapy for critically ill patients with left ventricular systolic dysfunction. Int J Cardiol 2011; 163:141-5. [PMID: 21664704 DOI: 10.1016/j.ijcard.2011.05.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 05/02/2011] [Accepted: 05/13/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The experience of cardiac resynchronization therapy (CRT) in critically ill patients with cardiogenic shock or advanced heart failure is limited and inadequately described in literature. METHODS CRT implants performed in patients on the cardiothoracic intensive care unit (ICU) at a tertiary cardiac centre during 2007-2010 were retrospectively studied. RESULTS We identified 24 patients, 17 male, of median age 76 years (IQR 11) treated with a CRT pacemaker (n=10) or CRT defibrillator (n=14). Prior to implantation median left ventricular ejection fraction (LVEF) was 26% (IQR 13) and median QRS duration 146 ms (IQR 29). Eleven (46%) patients were post elective cardiac surgery and 8 (33%) post emergency cardiac surgery or intervention with high prevalence of co-morbidities. Nineteen patients required inotropic support pre-implantation, 8 patients were on mechanical circulatory support and 18 were on mechanical ventilation. Post CRT LVEF improved from 26% to 39% (p=0.027) and the estimated glomerular filtration rate increased from 42 ml/min/1.73 m(2) (IQR 26) to 63 ml/min/1.73 m(2) (IQR 48, p=0.001). All but one patient were successfully weaned from inotropic support within a median of 4 days (IQR 5) post CRT and 22/24 (92%) survived to hospital discharge. After a median follow up of 392 days (IQR 538), 7 (33%) patients died. In-hospital and one year mortality rates were 8.3% and 29.4% respectively. Ten out of 12 patients (83%) were alive at long-term (22 ± 9 months) follow up. CONCLUSIONS CRT may assist weaning from circulatory and respiratory support in critically ill patients with left ventricular systolic dysfunction.
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Pechlivanidis G, Mantziari L, Giannakoulas G, Dimitroula H, Styliadis H, Karvounis H, Styliadis IH, Parharidis G. Effects of renin-angiotensin system inhibition on right ventricular function in patients with mild essential hypertension. J Renin Angiotensin Aldosterone Syst 2011; 12:358-64. [DOI: 10.1177/1470320310391334] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Systemic hypertension is known to affect both left and right ventricular (RV) function. Little is known about the effect of the renin—angiotensin system (RAS) inhibition on global RV function in patients with essential hypertension. Materials and methods: Forty patients (17 male, mean age 47 ± 10 years) with mild hypertension free of cardiovascular disease were assessed by echocardiography at baseline and after nine months of antihypertensive treatment with RAS inhibitors. Tissue Doppler imaging derived myocardial performance index (MPI) of the left and right ventricle was used as an index of global ventricular function. Results: Both left ventricular (LV) and RV MPI were increased at baseline and were reduced after treatment (LV MPI reduced from 0.42 ± 0.06 to 0.39 ± 0.05, p < 0.001 and RV MPI was reduced from 0.34 ± 0.06 to 0.32 ± 0.05, p < 0.005). There was a positive correlation between mitral and tricuspid E/A ratio both at baseline and at month nine after treatment ( r = 0.661, p < 0.001 and r = 0.503, p < 0.005 respectively). LV mass index and interventricular septum thickness were decreased after treatment. No correlation was found between MPI improvement and blood pressure reduction. Conclusions: RAS inhibition in patients with mild hypertension results in an improvement of RV global function which is unrelated to the reduction in blood pressure.
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Affiliation(s)
- Georgios Pechlivanidis
- First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lilian Mantziari
- First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece,
| | - Georgios Giannakoulas
- First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Hariklia Dimitroula
- First Propeadeutic Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
| | - Haralambos Styliadis
- First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haralambos Karvounis
- First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis H Styliadis
- First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Parharidis
- First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Mora B, Base E, Schmid W, Andreas M, Weber U, Junreitmaier M, Foerster F, Hiesmayr M, Tschernich HD, Guldbrand D, Goetzsche O, Eika B, Fumagalli S, Francini S, Gabbai D, Pedri S, Casalone Rinaldi M, Makhanian Y, Sollami R, Tarantini F, Marchionni N, Azcarate PM, Castano S, Rodriguez-Manero M, Arraiza M, Levy B, Barba J, Rabago G, Bastarrika G, Rus H, Radoi M, Ciurea C, Boda D, Erdei T, Denes M, Mihalcz A, Kardos A, Foldesi CS, Temesvari A, Lengyel M, Cameli M, Lisi M, Righini F, Ballo P, Henein M, Mondillo S, Nistri S, Galderisi M, Ballo PC, Pagliani L, Olivotto I, Santoro A, Papesso B, Innelli P, Cecchi F, Mondillo S, Hristova K, Katova TZ, Kostova V, Simova Y, Nesheva N, Ivanovic B, Tadic MT, Simic DS, Rao CM, Aguglia D, Casciola G, Imbesi C, Marvelli A, Sgro M, Benedetto D, Tripepi G, Zoccali C, Benedetto FA, Mantziari L, Kamperidis V, Damvopoulou E, Ventoulis I, Giannakoulas G, Paraskevaidis S, Vassilikos V, Karvounis H, Styliadis IH, Sonder TK, Loegstrup BB, Lambrechtsen J, Van Bortel LM, Segers P, Egstrup K, Tho A, Moceri P, Bertora D, Gibelin P, Cho EJ, Choi KY, Kim BJ, Kim DB, Jang SW, Park CS, Jung HO, Jeon HK, Youn HJ, Kim JH, Donal E, Coquerel N, Bodi S, Thebault C, Kervio G, Carre F, Daly MJ, Fairley SL, Doherty R, Ashfield K, Kirkpatrick R, Smith B, Buchanan J, Hill L, Dixon LJ, Rosca M, O' Connor K, Magne J, Romano G, Calin A, Popescu BA, Beladan CC, Pierard L, Ginghina C, Lancellotti P, Bochenek T, Wita K, Tabor Z, Grabka M, Elzbieciak M, Trusz-Gluza M, Moreau O, Thebault C, Kervio G, Leclercq C, Donal E, Sahlen A, Shahgaldi K, Aminoff A, Aagaard P, Manouras A, Winter R, Ehrenborg E, Braunschweig F, Bedetti G, Gargani L, Pizzi C, Sicari R, Picano E, Ballo P, Nistri S, Innelli P, Galderisi M, Mondillo S, Zhang J, Zhang HB, Duan YY, Chen LL, Li J, Liu LW, Zhu T, Li HL, Su HL, Zhou XD, Ruiz Ortiz M, Mesa Rubio D, Delgado Ortega M, Romo Penas E, Toledano Degado F, Leon Del Pino C, Lopez Aguilera J, Villanueva Fernandez E, Cejudo Diaz Del Campo L, Suarez De Lezo J, Abergel E, Simon M, Dehant P, Bogino E, Jimenez M, Verdier JC, Chauvel C, Albertsen AE, Nielsen JC, Mortensen PT, Egeblad H, Nasr GM, Tawfik S, Omar A, Olofsson M, Boman K, Sonder TK, Loegstrup BB, Lambrechtsen J, Segers P, Van Bortel LM, Egstrup K, Rezzoug N, Vaes B, Degryse J, Vanoverschelde JL, Pasquet AA, Poggio D, Bonadies M, Pacher V, Mazzetti S, Grillo M, D'elia E, Khouri T, Specchia G, Mornos C, Rusinaru D, Cozma D, Ionac A, Petrescu L, Rotzak R, Rosenman Y, Patterson RD, Ratnatheepan S, Bogle RG, Goebel B, Gjesdal O, Kottke D, Otto S, Jung C, Edvardsen T, Figulla HR, Poerner TC, Otsuka T, Suzuki M, Yoshikawa H, Hashimoto G, Itou N, Ono T, Yamamoto M, Osaki T, Tsuchida T, Sugi K, Wolber T, Haegeli L, Huerlimann D, Brunckhorst C, Duru F, Wu ZM, Shu XH, Dong LL, Fan B, Ge JB, Greutmann M, Tobler D, Biaggi P, Mah M, Crean A, Oechslin EN, Silversides CK, Ivanovic B, Tadic MT, Simic DS, Giusca S, Jurcut R, Ghiorghiu I, Coman IM, Popescu BA, Amzulescu M, Ionescu R, Delcroix M, Voigt JU, Ginghina C, Piatkowski R, Kochanowski J, Scislo P, Grabowski M, Marchel M, Roik M, Kosior D, Opolski G, Maceira Gonzalez AM, Cosin-Sales J, Dalli E, Igual B, Monmeneu JV, Lopez-Lereu P, Estornell J, Ruvira J, Sotillo J, Stevanovic A, Toncev A, Dimkovic S, Dekleva M, Paunovic N, Toncev D, Sekularac N, Yildirimturk O, Helvacioglu FF, Tayyareci Y, Yurdakul S, Demiroglu ICC, Aytekin S, Pinedo Gago M, Amat Santos I, Revilla Orodea A, Lopez Diaz J, Arnold R, De La Fuente Galan L, Recio Platero A, Gomez Salvador I, Puerto Sanz A, San Roman Calvar JA, Yotti R, Bermejo J, Mombiela T, Benito Y, Sanchez PL, Solis J, Prieto R, Fernandez-Aviles F, Zilberszac R, Gabriel H, Graf S, Mundigler G, Maurer G, Rosenhek R, Zito C, Salvia J, Longordo C, Donato D, Alati E, Miceli M, Pardeo A, Arcidiaco S, Oreto G, Carerj S, Kamperidis V, Hadjimiltiades S, Sianos G, Anastasiadis K, Grosomanidis V, Efthimiadis G, Karvounis H, Parcharidis G, Styliadis IH, Yousry M, Rickenlund A, Petrini J, Gustafsson T, Liska J, Hamsten A, Eriksson P, Franco-Cereceda A, Eriksson MJ, Caidahl K, Mizia-Stec K, Pysz P, Jasinski M, Drzewiecka-Gerber A, Krejca M, Bochenek A, Wos S, Gasior Z, Trusz-Gluza M, Tendera M, Yildirimturk O, Helvacioglu FF, Tayyareci Y, Yurdakul S, Demiroglu ICC, Aytekin S, Niki K, Sugawara M, Takamisawa I, Watanabe H, Sumiyoshi T, Hosoda S, Ida T, Takanashi S, Olsen NT, Sogaard P, Jons C, Mogelvang R, Larsson HBW, Goetze JP, Nielsen OW, Fritz-Hansen T, Sayar N, Orhan AL, Erer HB, Eren M, Atmaca H, Yilmaz HY, Cakmak N, Altay S, Terzi S, Yesilcimen K, Garcia Orta R, Moreno E, Lopez M, Uribe I, Vidal M, Ruiz-Lopez MF, Gonzalez-Molina M, Oyonarte JM, Lopez S, Azpitarte J, Szymanski C, Levine RA, Zheng H, Handschumacher MD, Tawakol A, Hung J, Le Ven F, Etienne Y, Jobic Y, Frachon I, Castellant P, Fatemi M, Blanc JJ, Rusinaru D, Tribouilloy C, Grigioni F, Avierinos JF, Barbieri A, Buiciuc O, Enriquez-Sarano M, Said K, Farag AK, El-Ramly M, Rizk H, Iorio A, Pinamonti B, Bobbo M, Merlo M, Massa L, Faganello G, Di Lenarda A, Sinagra G, Margato R, Ribeiro H, Ferreira C, Matias A, Fontes P, Moreira JI, Milan A, Puglisi E, Magnino C, Fabbri A, Leone D, Vairo A, Crudo V, Iannaccone A, Milazzo V, Veglio F, Maroz-Vadalazhskaya N, Ostrovskiy I, Zito C, Imbalzano E, Saitta A, Oreto G, Cusma-Piccione M, Di Bella G, Nava R, Ferro M, Falanga G, Carerj S, Frigy A, Buzogany J, Szabados CS, Dan L, Carasca E, Ikonomidis I, Lekakis J, Tzortzis S, Kremastinos DT, Papadopoulos C, Paraskevaidis I, Triantafyllidi H, Trivilou P, Venetsanou K, Anastasiou-Nana M, Wierzbowska-Drabik K, Kurpesa M, Trzos E, Rechcinski T, Mozdzan M, Kasprzak JD, Kosmala W, Kotwica T, Przewlocka-Kosmala M, Mysiak A, Skultetyova D, Filipova S, Chnupa P, Mantziari L, Pechlivanidis G, Giannakoulas G, Dimitroula H, Karvounis H, Styliadis IH, Milan A, Puglisi E, Magnino C, Fabbri A, Leone D, Vairo A, Iannaccone A, Crudo V, Milazzo V, Veglio F, Tsai WC, Liu YW, Lin CC, Huang YY, Tsai LM, Park SM, Kim YH, Shin SM, Shim WJ, Gonzalez Mansilla A, Torres Macho J, Sanchez Sanchez V, Diez P, Delgado J, Borruel S, Saenz De La Calzada C, Pyxaras S, Valentincic M, Barbati G, Lo Giudice F, Perkan A, Magnani S, Merlo M, Pinamonti B, Sinagra G, Palecek T, Ambroz D, Jansa P, Lindner J, Vitovec M, Polacek P, Jiratova K, Linhart A, Baskurt M, Dogan GM, Abaci O, Kaya A, Kucukoglu S, Duszanska A, Kukulski T, Skoczylas I, Majsnerowska A, Nowowiejska-Wiewiora A, Streb W, Szulik M, Polonski L, Kalarus Z, Yerly PO, Prella M, Joly A, Nicod L, Aubert JD, Aebischer N, Dores H, Leal S, Rosario I, Correia MJ, Monge J, Grilo AM, Arroja I, Fonseca C, Aleixo A, Silva A, Perez-David E, Sanchez-Alegre M, Yotti R, Gomez Anta I, De La Torre J, Alarcon J, Garcia Robles JA, Lafuente J, Bermejo J, Fernandez-Aviles F, Garcia Alonso CJ, Vallejo Camazon N, Gonzalez Guardia A, Nunez R, Bosch Carabante C, Mateu L, Gual Capllonch F, Ferrer Sistach E, Lopez Ayerbe J, Bayes Genis A, Tomaszewski A, Kutarski A, Tomaszewski M, Bramos D, Kalantaridou A, Takos D, Skaltsiotis E, Trika C, Tsirikos N, Pamboukas C, Kottis G, Toumanidis S, Aggeli C, Felekos I, Roussakis G, Kazazaki C, Lampropoulos K, Lagoudakou S, Stergiou C, Pitsavos C, Stefanadis C, Kihara C, Murata K, Wada Y, Tanaka T, Uchida K, Okuda S, Susa T, Matsuzaki M, Shahgaldi K, Manouras A, Abrahamsson A, Gudmundsson P, Brodin L, Winter R, Knebel F, Schattke S, Sanad W, Schimke I, Schroeckh S, Brechtel L, Lock J, Makauskiene R, Baumann G, Borges AC, Moelmen-Hansen HE, Wisloff U, Aamot IL, Stoylen A, Ingul CB, Estensen ME, Beitnes JO, Grindheim G, Henriksen T, Aaberge L, Smiseth OA, Gullestad L, Aakhus S, Gargani L, Agoston G, Moggi Pignone A, Capati E, Badano L, Moreo A, Bombardieri S, Varga A, Sicari R, Picano E, Carrideo M, Faricelli S, Corazzini A, Ippedico R, Ruggieri B, Di Blasio A, D'angelo E, Di Baldassarre A, Ripari P, Gallina S, Kentrschynskyj A, Rickenlund A, Caidahl K, Hylander B, Jacobson S, Pagels A, Eriksson MJ, Dumitrescu SI, Tintoiu I, Greere V, Cristian G, Chiriac L, Pinte F, Droc I, Neagoe G, Stanciu S, Voicu VA, Kuch-Wocial A, Pruszczyk P, Szmigielski CA, Szulc M, Styczynski G, Sinski M, Kaczynska A, Ryabikov A, Malyutina S, Halcox J, Bobak M, Nikitin YU, Marmot M, Barbosa D, Kiss G, Orderud F, Amundsen B, Jasaityte R, Loeckx D, Claus P, Torp H, D'hooge J, Kuhl JT, Lonborg J, Fuchs A, Andersen M, Vejlstrup N, Engstrom T, Moller JE, Kofoed KF, Smith LA, Bhan A, Paul M, Monaghan MJ, Zaborska B, Stec S, Sikora-Frac M, Krynski T, Kulakowski P, Pushparajah K, Dashwood D, Barlow A, Nugent K, Miller O, Simpson J, Valeur N, Ersboll MK, Kjaergaard J, Greibe R, Risum N, Hassager C, Sogaard P, Kober L, Sahlen A, Manouras A, Shahgaldi K, Winter R, Brodin L, Popovic D, Nedeljkovic I, Petrovic M, Vujisic-Tesic B, Arandjelovic A, Stojiljkovic S, Stojiljkovic S, Jakovljevic B, Damjanovic S, Ostojic M, Agrios IA, Bramos DB, Skaltsiotis HS, Takos DT, Kaladaridis A, Vasiladiotis NV, Kottis GK, Antoniou AA, Pamboucas CP, Toumanidis STT, Locorotondo G, Porto I, Paraggio L, Fedele E, Barchetta S, De Caterina AR, Rebuzzi AG, Crea F, Galiuto L, Lipiec P, Szymczyk E, Michalski B, Wozniakowski B, Stefanczyk L, Rotkiewicz A, Shim A, Kasprzak JD, Vainer J, Habets J, Lousberg A, Pont De C, Waltenberger J, Farouk H, Heshmat H, Adel A, El Chilali K, Baghdady Y, Sorour K, Gustafsson U, Larsson M, Bjallmark A, Lindqvist P, A'roch R, Haney M, Waldenstrom A, Mladenovic Z, Tavciovski D, Mijailovic Z, Djordjevic - Dikic A, Obradovic S, Matunovic R, Jovic Z, Djuric P, Torp H, Aase S, Dalen H, Sarkola T, Redington AN, Keeley F, Bradley T, Jaeggi E, Sahlen H, Winter R, Brodin L, Sahlen A, Olsen NT, Risum N, Jons C, Mogelvang R, Valeur N, Fritz-Hansen T, Sogaard P. Poster session IV * Friday 10 December 2010, 14:00-18:00. European Journal of Echocardiography 2010. [DOI: 10.1093/ejechocard/jeq146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Boufidou A, Mantziari L, Paraskevaidis S, Karvounis H, Nenopoulou E, Manthou ME, Styliadis IH, Parcharidis G. An interesting case of cardiac amyloidosis initially diagnosed as hypertrophic cardiomyopathy. Hellenic J Cardiol 2010; 51:552-557. [PMID: 21169191] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Cardiac involvement occurs frequently in primary amyloidosis and is associated with heart failure hospitalizations and poor survival. The initial presentation of the disease may be misleading, resulting in under-diagnosis of cardiac amyloidosis and late initiation of treatment. We present a case of cardiac amyloidosis initially misdiagnosed as hypertrophic cardiomyopathy and we discuss the key findings of the disease along with the latest evidence regarding the management and prognosis of cardiac amyloidosis.
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Affiliation(s)
- Amalia Boufidou
- First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
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Paraskevaidis S, Theofilogiannakos EK, Chatzizisis YS, Mantziari L, Economou F, Ziakas A, Hadjimiltiades S, Styliadis IH. Spontaneous dissection of right coronary artery manifested with acute myocardial infarction. Open Cardiovasc Med J 2010; 4:178-80. [PMID: 21127744 PMCID: PMC2995159 DOI: 10.2174/1874192401004010178] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 07/21/2010] [Accepted: 07/23/2010] [Indexed: 11/22/2022] Open
Abstract
Spontaneous coronary artery dissection is a rare cause of acute ischemic coronary events and sudden cardiac death. It usually occurs in young women without traditional risk factors for coronary artery disease during pregnancy or postpartum period. However, it has also been reported in patients with atherosclerotic coronary disease. We present a case of spontaneous right coronary artery dissection in a 48-year male with recent myocardial infarction and previous percutaneous coronary intervention.
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Affiliation(s)
- Stelios Paraskevaidis
- 1 Cardiology Department, AHEPA Hospital, Aristotle University Medical School, Thessaloniki, Greece
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Vassilikos VP, Vogas V, Giannakoulas G, Mantziari L, Lekka I, Dimitrakopoulos K, Paraskevaidis S, Konias S, Maglaveras N, Chouvarda I, Styliadis H, Styliadis IH. The Use of Transtelephonic Loop Recorders for the Assessment of Symptoms and Arrhythmia Recurrence After Radiofrequency Catheter Ablation. Telemed J E Health 2010; 16:792-8. [DOI: 10.1089/tmj.2010.0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vassilios P. Vassilikos
- First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios Vogas
- First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Giannakoulas
- First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lilian Mantziari
- First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Lekka
- Lab of Medical Informatics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Stelios Paraskevaidis
- First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sokratis Konias
- Lab of Medical Informatics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Maglaveras
- Lab of Medical Informatics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Chouvarda
- Lab of Medical Informatics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haralambos Styliadis
- Lab of Medical Informatics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis H. Styliadis
- First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Mantziari L, Styliadis C, Kourtidou-Papadeli C, Styliadis I. Arrhythmias, sudden cardiac death and incapacitation of pilots. Hippokratia 2008; 12:53-8. [PMID: 19050752 PMCID: PMC2577402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Inflight medical emergencies occur at a rate of 20 to 100 per million passengers, with a death rate of 0.1 to 1 per million. Cardiac, neurologic, and respiratory complaints comprise the more serious emergencies, as defined by aircraft diversion or use of ground-based medical assistance. In this paper, we review changes seen in the resting electrocardiogram in normal individuals exposed to high altitude, alongside important implications for patients with heart diseases in high altitude exposures and the possible effects of high altitude to permanent cardiac pacemakers. Arrhythmias in pilots and public safety are revisited together with the guidelines of the Joint Aviation Requirements (JAR) in Europe. The situation of Military flights is also discussed. Physicians ought to become knowledgeable about the specific medical job standards for their patients when asked to render opinions regarding fitness to fly. A database must be established to obtain prospective data that defines the risk of accidents in patients who are or were being treated for arrhythmias. Current guidelines could then be updated and revised as appropriate.
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Affiliation(s)
- L Mantziari
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
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