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Maclean E, Mahtani K, Roelas M, Vyas R, Butcher C, Ahluwalia N, Honarbakhsh S, Creta A, Finlay M, Chow A, Earley MJ, Sporton S, Lowe MD, Sawhney V, Ezzat V, Ahsan S, Khan F, Dhinoja M, Lambiase PD, Schilling RJ, Hunter RJ, Segal OR. Transseptal puncture for left atrial ablation: risk factors for cardiac tamponade and a proposed causative classification system. J Cardiovasc Electrophysiol 2022; 33:1747-1755. [PMID: 35671359 PMCID: PMC9543389 DOI: 10.1111/jce.15590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022]
Abstract
Aims Cardiac tamponade is a high morbidity complication of transseptal puncture (TSP). We examined the associations of TSP‐related cardiac tamponade (TRCT) for all patients undergoing left atrial ablation at our center from 2016 to 2020. Methods and Results Patient and procedural variables were extracted retrospectively. Cases of cardiac tamponade were scrutinized to adjudicate TSP culpability. Adjusted multivariate analysis examined predictors of TRCT. A total of 3239 consecutive TSPs were performed; cardiac tamponade occurred in 51 patients (incidence: 1.6%) and was adjudicated as TSP‐related in 35 (incidence: 1.1%; 68.6% of all tamponades). Patients of above‐median age [odds ratio (OR): 2.4 (1.19–4.2), p = .006] and those undergoing re‐do procedures [OR: 1.95 (1.29–3.43, p = .042] were at higher risk of TRCT. Of the operator‐dependent variables, choice of transseptal needle (Endrys vs. Brockenbrough, p > .1) or puncture sheath (Swartz vs. Mullins vs. Agilis vs. Vizigo vs. Cryosheath, all p > .1) did not predict TRCT. Adjusting for operator, equipment and demographics, failure to cross the septum first pass increased TRCT risk [OR: 4.42 (2.45–8.2), p = .001], whilst top quartile operator experience [OR: 0.4 (0.17–0.85), p = .002], transoesophageal echocardiogram [TOE prevalence: 26%, OR: 0.51 (0.11–0.94), p = .023], and use of the SafeSept transseptal guidewire [OR: 0.22 (0.08–0.62), p = .001] reduced TRCT risk. An increase in transseptal guidewire use over time (2016: 15.6%, 2020: 60.2%) correlated with an annual reduction in TRCT (R2 = 0.72, p < .001) and was associated with a relative risk reduction of 70%. Conclusions During left atrial ablation, the risk of TRCT was reduced by operator experience, TOE‐guidance, and use of a transseptal guidewire, and was increased by patient age, re‐do procedures, and failure to cross the septum first pass.
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Affiliation(s)
- E Maclean
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - K Mahtani
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M Roelas
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - R Vyas
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - C Butcher
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - N Ahluwalia
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - S Honarbakhsh
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - A Creta
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M Finlay
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - A Chow
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M J Earley
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - S Sporton
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M D Lowe
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - V Sawhney
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - V Ezzat
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - S Ahsan
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - F Khan
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M Dhinoja
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - P D Lambiase
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - R J Schilling
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - R J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - O R Segal
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
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Sawhney V, Mc Lellan A, Chatha S, Perera D, Aderonke A, Juno S, Whittaker-Axon S, Daw H, Garcia J, Lambiase PD, Cullen S, Bhan A, Von Klemperer K, Walker F, Pandya B, Lowe MD, Ezzat V. Outcome of ACHD patients with non-inducible versus inducible IART undergoing cavo-tricuspid isthmus ablation: the role of empiric ablation. J Interv Card Electrophysiol 2020; 60:49-56. [PMID: 31997041 DOI: 10.1007/s10840-019-00692-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Catheter ablation for supraventricular tachycardia (SVT) in adults with congenital heart disease (ACHD) is an important therapeutic option. Cavo-tricuspid isthmus (CTI)-dependent intraatrial re-entrant tachycardia (IART) is common. However, induction of sustained tachycardia at the time of ablation is not always possible. We hypothesised that performing an empiric CTI line in case of non-inducibility leads to good outcomes. Long-term outcomes of empiric versus entrained CTI ablation in ACHD patients were examined. METHODS Retrospective, single-centre, case-control study over 7 years. Arrhythmia-free survival after empiric versus entrained CTI ablation was compared. RESULTS Eighty-seven CTI ablations were performed in 85 ACHD patients between 2010 and 2017. The mean age of the cohort was 43 years and 48% were male. Underlying aetiology included ASD (31%), VSD (11.4%), AVSD (9.1%), AVR (4.8%), Fallot's (18.4%), Ebstein's (2.3%), Fontan's palliation (9.2%) and atrial switch (13.8%). CTI-dependent IART was entrained in 59 patients whereas it was non-inducible in 28. The latter had an empiric CTI ablation. Forty-three percent of procedures were performed under general anaesthesia. There were no reported procedural complications. There was no significant difference in the mean procedure or fluoroscopy times between the groups (empiric vs entrained CTI; 169.1 vs 183.3 and 28.1 vs 19.9 min). Arrhythmia-free survival was 64.3% versus 72.8% (p value 0.44) in the empiric and entrained groups at 21 months follow-up. CONCLUSIONS Long-term outcomes after empiric and entrained CTI ablation for IART in ACHD patients are comparable. This is a safe and effective therapeutic option. In the case of non-inducibility of IART, an empiric CTI line should be considered in this cohort.
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Affiliation(s)
- V Sawhney
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK. .,Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
| | - A Mc Lellan
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - S Chatha
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - D Perera
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - A Aderonke
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - S Juno
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - S Whittaker-Axon
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - H Daw
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK.,Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - J Garcia
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - P D Lambiase
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - S Cullen
- Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - A Bhan
- Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - K Von Klemperer
- Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - F Walker
- Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - B Pandya
- Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - M D Lowe
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK.,Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - V Ezzat
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK.,Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
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Martin CA, Orini M, Srinivasan NT, Bhar-Amato J, Honarbakhsh S, Chow AW, Lowe MD, Ben-Simon R, Elliott PM, Taggart P, Lambiase PD. Assessment of a conduction-repolarisation metric to predict Arrhythmogenesis in right ventricular disorders. Int J Cardiol 2018; 271:75-80. [PMID: 29871808 PMCID: PMC6152588 DOI: 10.1016/j.ijcard.2018.05.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The re-entry vulnerability index (RVI) is a recently proposed activation-repolarization metric designed to quantify tissue susceptibility to re-entry. This study aimed to test feasibility of an RVI-based algorithm to predict the earliest endocardial activation site of ventricular tachycardia (VT) during electrophysiological studies and occurrence of haemodynamically significant ventricular arrhythmias in follow-up. METHODS Patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) (n = 11), Brugada Syndrome (BrS) (n = 13) and focal RV outflow tract VT (n = 9) underwent programmed stimulation with unipolar electrograms recorded from a non-contact array in the RV. RESULTS Lowest values of RVI co-localised with VT earliest activation site in ARVC/BrS but not in focal VT. The distance between region of lowest RVI and site of VT earliest site (Dmin) was lower in ARVC/BrS than in focal VT (6.8 ± 6.7 mm vs 26.9 ± 13.3 mm, p = 0.005). ARVC/BrS patients with inducible VT had lower Global-RVI (RVIG) than those who were non-inducible (-54.9 ± 13.0 ms vs -35.9 ± 8.6 ms, p = 0.005) or those with focal VT (-30.6 ± 11.5 ms, p = 0.001). Patients were followed up for 112 ± 19 months. Those with clinical VT events had lower Global-RVI than both ARVC and BrS patients without VT (-54.5 ± 13.5 ms vs -36.2 ± 8.8 ms, p = 0.007) and focal VT patients (-30.6 ± 11.5 ms, p = 0.002). CONCLUSIONS RVI reliably identifies the earliest RV endocardial activation site of VT in BrS and ARVC but not focal ventricular arrhythmias and predicts the incidence of haemodynamically significant arrhythmias. Therefore, RVI may be of value in predicting VT exit sites and hence targeting of re-entrant arrhythmias.
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Affiliation(s)
- C A Martin
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK; Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - M Orini
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK; Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - N T Srinivasan
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK; Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - J Bhar-Amato
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - S Honarbakhsh
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - A W Chow
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - M D Lowe
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - R Ben-Simon
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - P M Elliott
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - P Taggart
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - P D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK; Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK.
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Honarbakhsh S, Schilling RJ, Providencia R, Keating E, Chow A, Sporton S, Lowe MD, Earley MJ, Hunter RJ. P1152Characterization of localized drivers that play a mechanistic role in persistent atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.638] [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: 11/14/2022] Open
Affiliation(s)
- S Honarbakhsh
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - R J Schilling
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - R Providencia
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - E Keating
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - A Chow
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - S Sporton
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - M D Lowe
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - M J Earley
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - R J Hunter
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
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Srinivasan NT, Orini M, Providencia R, Simon RB, Lowe MD, Segal OR, Chow AW, Ahsan S, Schilling RJ, Hunter R, Taggart P, Lambiase PD. 25First evidence that differences in the t-wave upslope of the body surface ECG reflect right to left dispersion of repolarization in the intact human heart. Europace 2017. [DOI: 10.1093/europace/eux283.034] [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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Martin CA, Sawhney V, Martin R, Takigawa M, Frontera A, Cheniti G, Thompson N, Massouillie G, Kitamura T, Wolf M, Duchateau J, Vlachos K, Denis A, Pambrun T, Sacher F, Hocini M, Jais P, Haissaguerre M, Ezzat V, Lowe MD, Derval N. 77USe of ultra-high density activation mapping to aid isthmus identification in atrial macro-reentrant tachycardias in complex congenital heart disease. Europace 2017. [DOI: 10.1093/europace/eux283.072] [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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Srinivasan NT, Orini M, Providencia R, Martin C, Dhinoja M, Hunter R, Lowe MD, Khan F, Taggart PD, Schilling RJ, Lambiase PD. 105Investigation of the transmural action potential duration and repolarization properties of scar borderzone in patients undergoing ventricular tachycardia ablation. Europace 2017. [DOI: 10.1093/europace/eux283.099] [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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Ahsan SY, Saberwal B, Lambiase PD, Koo CY, Lee S, Gopalamurugan AB, Rogers DP, Lowe MD, Chow AWC. A simple infection-control protocol to reduce serious cardiac device infections. Europace 2014; 16:1482-9. [DOI: 10.1093/europace/euu126] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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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McCready J, Chow AW, Lowe MD, Segal OR, Ahsan S, de Bono J, Dhaliwal M, Mfuko C, Ng A, Rowland ER, Bradley RJW, Paisey J, Roberts P, Morgan JM, Sandilands A, Yue A, Lambiase PD. Safety and efficacy of multipolar pulmonary vein ablation catheter vs. irrigated radiofrequency ablation for paroxysmal atrial fibrillation: a randomized multicentre trial. Europace 2014; 16:1145-53. [PMID: 24843051 PMCID: PMC4114331 DOI: 10.1093/europace/euu064] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Aims The current challenge in atrial fibrillation (AF) treatment is to develop effective, efficient, and safe ablation strategies. This randomized controlled trial assesses the medium-term efficacy of duty-cycled radiofrequency ablation via the circular pulmonary vein ablation catheter (PVAC) vs. conventional electro-anatomically guided wide-area circumferential ablation (WACA). Methods and results One hundred and eighty-eight patients (mean age 62 ± 12 years, 116 M : 72 F) with paroxysmal AF were prospectively randomized to PVAC or WACA strategies and sequentially followed for 12 months. The primary endpoint was freedom from symptomatic or documented >30 s AF off medications for 7 days at 12 months post-procedure. One hundred and eighty-three patients completed 12 m follow-up. Ninety-four patients underwent PVAC PV isolation with 372 of 376 pulmonary veins (PVs) successfully isolated and all PVs isolated in 92 WACA patients. Three WACA and no PVAC patients developed tamponade. Fifty-six percent of WACA and 60% of PVAC patients were free of AF at 12 months post-procedure (P = ns) with a significant attrition rate from 77 to 78%, respectively, at 6 months. The mean procedure (140 ± 43 vs. 167 ± 42 min, P<0.0001), fluoroscopy (35 ± 16 vs. 42 ± 20 min, P<0.05) times were significantly shorter for PVAC than for WACA. Two patients developed strokes within 72 h of the procedure in the PVAC group, one possibly related directly to PVAC ablation in a high-risk patient and none in the WACA group (P = ns). Two of the 47 patients in the PVAC group who underwent repeat ablation had sub-clinical mild PV stenoses of 25–50% and 1 WACA patient developed delayed severe PV stenosis requiring venoplasty. Conclusion The pulmonary vein ablation catheter is equivalent in efficacy to WACA with reduced procedural and fluoroscopy times. However, there is a risk of thrombo-embolic and pulmonary stenosis complications which needs to be addressed and prospectively monitored. ClinicalTrials.gov Identifier NCT00678340.
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Affiliation(s)
- J McCready
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - A W Chow
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - M D Lowe
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - O R Segal
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - S Ahsan
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - J de Bono
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - M Dhaliwal
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - C Mfuko
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - A Ng
- Cardiology Department, Glenfield Heart Centre, Leicester, Leicestershire LE39QP, UK
| | - E R Rowland
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - R J W Bradley
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - J Paisey
- Cardiology Department, Royal Bournemouth Hospital Castle Lane East Bournemouth, Bournemouth BH7 7DW, UK
| | - P Roberts
- Cardiology Department, Southampton General Hospital, Southampton, Hampshire SO16 6YD, UK
| | - J M Morgan
- Cardiology Department, Southampton General Hospital, Southampton, Hampshire SO16 6YD, UK
| | - A Sandilands
- Cardiology Department, Glenfield Heart Centre, Leicester, Leicestershire LE39QP, UK
| | - A Yue
- Cardiology Department, Southampton General Hospital, Southampton, Hampshire SO16 6YD, UK
| | - P D Lambiase
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
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Phan TT, Khan S, Dewhurst M, Lee D, James S, de Belder M, Linker NJ, Thornley A, Turley AJ, Ahmed FZ, Arumugam P, Allen S, Daniels K, Clarke B, Mamas M, James J, Zaidi AM, Ullah W, Hunter R, Lovell M, Dhinoja M, Earley M, Sporton S, Schilling R, Raju H, Hedley P, Arno G, Ware J, Jeffery S, Cook S, Christiansen M, Behr ER, Sohal M, Chen Z, Sammut E, Jackson T, Child N, Wright M, O'Neill M, Cooklin M, Gill J, Carr-White G, Razavi R, Rinaldi CA, Nunn LM, Lopes L, Syrris P, Plagnol V, Firman E, Dalageorgou C, Domingo D, Zorio E, Murday V, Findlay I, Duncan A, Fynn S, White A, Goddard M, Carr-White G, Robert L, Bueser T, Langman C, Bundgaard H, Ferrero-Miliani L, Wheeldon N, O'Beirne A, Suvarna SK, Lowe MD, McKenna WJ, Elliott PM, Lambiase PD. YOUNG INVESTIGATORS COMPETITION, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut313] [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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Lee G, Hunter R, Lovell M, Finlay M, Sawhney V, Ullah W, Diab I, Dhinoja M, Earley M, Sporton S, Schilling RJ, Williams SE, Linton NWF, Harrison J, Wright M, O'Neill M, Jamil-Copley S, Linton N, Koa-Wing M, Lim PB, Hayat S, Qureshi N, Whinnett Z, Davies W, Peters N, Francis D, Kanagaratnam P, Jamil-Copley S, Ryan B, Kojodjojo P, Qureshi N, Koa-Wing M, Hayat S, Kyriacou A, Sandler B, Sohaib A, Wright I, Davies W, Peters N, Whinnett Z, Kanagaratnam P, Lim PB, Qureshi NA, Bai W, Ariff B, Williams A, Monro C, Kim S, Jamil-Copley S, Hayat S, Kao-Wing M, Kyriacou A, Sandler B, Fu NS, Kanagaratnam P, Whinnett Z, Davies DW, Lefroy D, Peters NS, Lim PB, Ryan MJ, Ezzat VA, O'Leary J, Bull C, Chow A, Lambiase P, Lowe MD, Anwar AS, Collitt S, Iddon P, Rice N, Dodd M, Dunsdale A, Petkar S, Mudd J, Linker N, Fitzpatrick AP, Fraser S, Choo WK, Padfield G, Rushworth G, Bloe C, Forsyth P, Cross SJ, Leslie SJ, Phan TT, Dewhurst M, Lee D, Williams D, James S, Thornley A, de Belder M, Linker N, Turley A, Campbell NG, Cantor E, Sawhney V, Duncan ER, Demartini C, Baker V, Diab IG, Dhinoja M, Earley MJ, Sporton S, Davies LC, Schilling RJ, Pettit SJ, Randles DA, Shaw M, Hawkins NM, Wright DJ, Lambiase PD, Barr C, Knops R, Neuzil P, Theuns D, Johansen JB, Hood M, Pederson S, Reeve HL, Boersma L. ABSTRACTS FOR ORAL PRESENTATION, SESSION 3, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut316] [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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Fabritz L, Fortmuller L, Vloumidi E, Yue TY, Syeda F, Kirchhof P, Leube R, Krusche C, Chin SH, Winter J, Brack KE, Ng GA, Ng FS, Holzem KM, Koppel AC, Janks D, Wit AL, Peters NS, Efimov IR, Chowdhury RA, El-Harasis MA, Dupont E, Terracciano CMN, Peters NS, Mellor GJ, Raju H, de Noronha SV, Papadakis M, Sharma S, Behr ER, Sheppard MN, Jamil-Copley S, Bai W, Ariff B, Lim PB, Koa-Wing M, Kyriacou A, Hayat S, Sohaib A, Qureshi N, Sandler B, O'Regan D, Whinnett Z, Davies W, Rueckert D, Kanagaratnam P, Peters N, Lambiase PD, Chow AW, Lowe MD, Segal OR, Ahsan S, de Bono J, Dhaliwal M, Mfuko C, Ng A, Sandilands A, Paisey J, Roberts P, Morgan JM, McCready J, Yue A, Ullah W, Hunter R, Lovell M, Dhinoja M, Sporton S, Earley M, Schilling R, Ghosh J, Martin A, Keech A, Chan KH, Gomes S, Singarayar S, McGuire M, Lee G, Hunter R, Berriman T, Diab I, Kamdar R, Richmond L, Baker V, Goromonzi F, Sawhney V, Duncan E, Unsworth B, Mayet J, Abrams D, Dhinoja M, Sporton S, Earley M, Schilling RJ, Bowers RW, Mulholland V, Balasubramaniam RN, Paisey JR, Sopher SM, Chu GS, Chin SH, Winter J, Armstrong S, Masca N, Almeida TP, Brown PD, Sandilands AJ, Schlindwein FS, Ng GA. ABSTRACTS FOR ORAL PRESENTATION, SESSION 2, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut315] [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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Abstract
Events leading to the deaths of two fillies at pasture are described. Pasture hay containing the flowering stages of Senecio jacobea (ragwort) had been fed three to four months earlier. Paddocks were subdivided with posts and rails treated with copper chrome arsenate. Six horses on the property chewed rails spasmodically. Both fillies presented with haemoglobinurea. Values in liver of 83 mg Cu kg and kidney 35 mg Cu kg wet weight and serum 1.4 mg Cu/l together with histophathology of seneciosis support a sequence of ragwort poisoning followed by copper accumulation in liver and kidney terminating in a haemolytic crisis. The source of copper appeared to he from wood containing concentrations of copper of 0.17% at the core and 1.68% in shavings from surface of treated timber.
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Affiliation(s)
- H F Dewes
- Hamilton Analytical Laboratory, Hamilton East
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McCready JW, Smedley T, Lambiase PD, Ahsan SY, Segal OR, Rowland E, Lowe MD, Chow AW. Predictors of recurrence following radiofrequency ablation for persistent atrial fibrillation. Europace 2010; 13:355-61. [DOI: 10.1093/europace/euq434] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [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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Rogers DPS, England F, Lozhkin K, Lowe MD, Lambiase PD, Chow AWC. Improving safety in the electrophysiology laboratory using a simple radiation dose reduction strategy: a study of 1007 radiofrequency ablation procedures. Heart 2010; 97:366-70. [DOI: 10.1136/hrt.2010.204222] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Lambiase PD, Ahmed AK, Ciaccio EJ, Brugada R, Lizotte E, Chaubey S, Ben-Simon R, Chow AW, Lowe MD, McKenna WJ. High-density substrate mapping in Brugada syndrome: combined role of conduction and repolarization heterogeneities in arrhythmogenesis. Circulation 2009; 120:106-17, 1-4. [PMID: 19564561 DOI: 10.1161/circulationaha.108.771401] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Two principal mechanisms are thought to be responsible for Brugada syndrome (BS): (1) right ventricular (RV) conduction delay and (2) RV subepicardial action potential shortening. This in vivo high-density mapping study evaluated the conduction and repolarization properties of the RV in BS subjects. METHODS AND RESULTS A noncontact mapping array was positioned in the RV of 18 BS patients and 20 controls. Using a standard S(1)-S(2) protocol, restitution curves of local activation time and activation recovery interval were constructed to determine local maximal restitution slopes. Significant regional conduction delays in the anterolateral free wall of the RV outflow tract of BS patients were identified. The mean increase in delay was 3-fold greater in this region than in control (P=0<0.001). Local activation gradient was also maximally reduced in this area: 0.33+/-0.1 (mean+/-SD) mm/ms in BS patients versus 0.51+/-0.15 mm/ms in controls (P<0.0005). The uniformity of wavefront propagation as measured by the square of the correlation coefficient, r(2), was greater in BS patients versus controls (0.94+/-0.04 versus 0.89+/-0.09 [mean+/-SD]; P<0.05). The odds ratio of BS hearts having any RV segment with maximal restitution slope >1 was 3.86 versus controls. Five episodes of provoked ventricular tachycardia arose from wave breaks originating from RV outflow tract slow-conduction zones in 5 BS patients. CONCLUSIONS Marked regional endocardial conduction delay and heterogeneities in repolarization exist in BS. Wave break in areas of maximal conduction delay appears to be critical in the initiation and maintenance of ventricular tachycardia. These data indicate that further studies of mapping BS to identify slow-conduction zones should be considered to determine their role in spontaneous ventricular arrhythmias.
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Affiliation(s)
- P D Lambiase
- Heart Hospital, University College Hospital, University College London, London, UK.
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17
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Lowe MD, Rowland E, Brown MJ, Grace AA. β 2 Adrenergic receptors mediate important electrophysiological effects in human ventricular myocardium. Heart 2001. [DOI: 10.1136/hrt.86.1.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVETo define the effects of β2 adrenergic receptor stimulation on ventricular repolarisation in vivo.DESIGNProspective study.SETTINGTertiary referral centre.PATIENTS85 patients with coronary artery disease and 22 normal controls.INTERVENTIONSIntravenous and intracoronary salbutamol (a β2 adrenergic receptor selective agonist; 10–30 μg/min and 1–10 μg/min), and intravenous isoprenaline (a mixed β1/β2adrenergic receptor agonist; 1–5 μg/min), infused during fixed atrial pacing.MAIN OUTCOME MEASURESQT intervals, QT dispersion, monophasic action potential duration.RESULTSIn patients with coronary artery disease, salbutamol decreased QTonset and QTpeak but increased QTend duration; QTonset–QTpeak and QTpeak–QTend intervals increased, resulting in T wave prolongation (mean (SEM): 201 (2) ms to 233 (2) ms; p < 0.01). There was a large increase in dispersion of QTonset, QTpeak, and QTend which was more pronounced in patients with coronary artery disease—for example, QTend dispersion: 50 (2) ms baselinev 98 (4) ms salbutamol (controls), and 70 (1) ms baseline v 108 (3) ms salbutamol (coronary artery disease); p < 0.001. Similar responses were obtained with isoprenaline. Monophasic action potential duration at 90% repolarisation shortened during intracoronary infusion of salbutamol, from 278 (4.1) ms to 257 (3.8) ms (p < 0.05).CONCLUSIONSβ2adrenergic receptors mediate important electrophysiological effects in human ventricular myocardium. The increase in dispersion of repolarisation provides a mechanism whereby catecholamines acting through this receptor subtype may trigger ventricular arrhythmias.
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Abstract
OBJECTIVE To define the effects of beta(2) adrenergic receptor stimulation on ventricular repolarisation in vivo. DESIGN Prospective study. SETTING Tertiary referral centre. PATIENTS 85 patients with coronary artery disease and 22 normal controls. INTERVENTIONS Intravenous and intracoronary salbutamol (a beta(2) adrenergic receptor selective agonist; 10-30 microg/min and 1-10 microg/min), and intravenous isoprenaline (a mixed beta(1)/beta(2) adrenergic receptor agonist; 1-5 microg/min), infused during fixed atrial pacing. MAIN OUTCOME MEASURES QT intervals, QT dispersion, monophasic action potential duration. RESULTS In patients with coronary artery disease, salbutamol decreased QT(onset) and QT(peak) but increased QT(end) duration; QT(onset)-QT(peak) and QT(peak)-QT(end) intervals increased, resulting in T wave prolongation (mean (SEM): 201 (2) ms to 233 (2) ms; p < 0.01). There was a large increase in dispersion of QT(onset), QT(peak), and QT(end) which was more pronounced in patients with coronary artery disease-for example, QT(end) dispersion: 50 (2) ms baseline v 98 (4) ms salbutamol (controls), and 70 (1) ms baseline v 108 (3) ms salbutamol (coronary artery disease); p < 0.001. Similar responses were obtained with isoprenaline. Monophasic action potential duration at 90% repolarisation shortened during intracoronary infusion of salbutamol, from 278 (4.1) ms to 257 (3.8) ms (p < 0.05). CONCLUSIONS beta(2) adrenergic receptors mediate important electrophysiological effects in human ventricular myocardium. The increase in dispersion of repolarisation provides a mechanism whereby catecholamines acting through this receptor subtype may trigger ventricular arrhythmias.
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Affiliation(s)
- M D Lowe
- Department of Cardiology, Papworth Hospital, Papworth Everard, Cambridge CB3 8RE, UK
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Abstract
A 29-year-old man developed recurrent syncope following exertion. Cardiac investigations revealed no evidence of structural heart disease, but during exercise testing, in the recovery phase, he sustained a bradycardia and then asystole for a prolonged period. Before cardiac massage could be instituted a tonic-clonic fit occurred, and this initiated a return to sinus rhythm. His symptoms were abolished following the implantation of a dual-chamber pacemaker.
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Affiliation(s)
- M D Lowe
- Cardiac Unit, Papworth Hospital, Papworth Everard, Cambridge CB3 8RE, UK
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20
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Abstract
Inferior vena caval pressures were measured in 60 patients undergoing cardiac catheterization and compared with central venous pressure from within the right atrium. Mean pressures within the abdominal inferior vena cava were essentially the same as mean right atrial pressure, suggesting that the inferior vena cava provides a useful safe alternative for measuring central venous pressure.
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Affiliation(s)
- J T Walsh
- Department of Cardiology, Papworth Hospital, Papworth Everard, Cambridgeshire, United Kingdom
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Hildick-Smith DJ, Walsh JT, Lowe MD, Stone DL, Schofield PM, Shapiro LM, Petch MC. Coronary angiography in the presence of peripheral vascular disease: femoral or brachial/radial approach? Catheter Cardiovasc Interv 2000; 49:32-7. [PMID: 10627362 DOI: 10.1002/(sici)1522-726x(200001)49:1<32::aid-ccd6>3.0.co;2-#] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Peripheral vascular disease is considered a relative contraindication to the femoral approach for coronary angiography, but no data exist comparing the femoral and brachial/radial routes under these circumstances. We examined the influence of vascular approach on outcome. Two hundred and ninety-seven patients, mean age 67.1 +/- 8.4 years, with clinical or radiographic evidence of aortofemoral peripheral arterial disease underwent diagnostic coronary angiography during a 3-year period at this cardiothoracic center. The approach was successful in 121 of 154 femoral cases (79%) compared with 130 of 143 brachial/radial cases (91%; P < 0.01). Of the 33 failed femoral cases, 15 were then approached from the other femoral artery, with success in 6 (40%), while 18 were approached from the arm, with success in all (100%; P < 0.01). Brachial/radial cases took significantly longer than femoral cases (51 +/- 19 vs. 42 +/- 22 mins; P < 0.01). In cases where the femoral pulse was considered normal, the femoral approach nonetheless failed in 19 of 95 (20%). Major vascular complications (e.g., pulseless limb, arterial dissection, hemorrhage, or false aneurysm) occurred in nine femoral cases vs. zero brachial/radial cases (P < 0.01). Patients with peripheral vascular disease who undergo coronary angiography from the femoral artery have a 1-in-5 risk of procedural failure, necessitating use of an alternative vascular approach, and a 1-in-20 risk of a major vascular complication. Normality of femoral arterial pulsation is not a good predictor of femoral success. Brachial/radial approaches take longer, but succeed more frequently and have a negligible major vascular complication rate. We believe that patients with peripheral vascular disease should undergo coronary angiography via brachial or radial approach. Cathet. Cardiovasc. Intervent. 49:32-37, 2000.
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Affiliation(s)
- D J Hildick-Smith
- Department of Cardiology, Papworth Hospital, Cambridgeshire, United Kingdom.
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Lowe MD, Grace AA, Kaumann AJ. Blockade of putative beta4- and beta1-adrenoceptors by carvedilol in ferret myocardium. Naunyn Schmiedebergs Arch Pharmacol 1999; 359:400-3. [PMID: 10498290 DOI: 10.1007/pl00005367] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The putative beta4-adrenoceptor mediates positive inotropic effects, action potential shortening and arrhythmias in ferret ventricle. Here we compared the affinity of carvedilol at the putative beta4-adrenoceptor and beta1-adrenoceptor, activated by (+/-)-CGP 12177 and (-)-isoprenaline, respectively. In paced right ventricular preparations, carvedilol (0.01-10 micromol/l) was a simple competitive antagonist of the positive inotropic effects of (+/-)-CGP 12177 (slope of Schild-plot = 1.02, pK(B) = 6.8) and (-)-isoprenaline (slope of Schild-plot = 0.98, pK(B) = 8.1). Carvedilol also blocked putative beta4- and beta1-adrenoceptors of left ventricle, left atrium and sino-atrial pacemaker. Carvedilol therefore interacts with the putative beta4-adrenoceptor according to the law of mass action and may provide a lead in the development of putative beta4-adrenoceptor-selective antagonists.
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Affiliation(s)
- M D Lowe
- Department of Biochemistry, University of Cambridge, UK
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Affiliation(s)
- M D Lowe
- Department of Cardiology, Papworth Hospital, Cambridge CB3 8RE
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Lowe MD, Grace AA, Vandenberg JI, Kaumann AJ. Action potential shortening through the putative beta4-adrenoceptor in ferret ventricle: comparison with beta1- and beta2-adrenoceptor-mediated effects. Br J Pharmacol 1998; 124:1341-4. [PMID: 9723943 PMCID: PMC1565553 DOI: 10.1038/sj.bjp.0702013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 11/09/2022] Open
Abstract
The electrophysiological responses to (-)-CGP 12177 ((-)-4-(3-tertiarybutylamino-2-hydroxypropoxy) benzimidazol-2-one), an agonist for the putative beta4-adrenoceptor, were investigated on isolated perfused ferret hearts paced at 100 min(-1) and compared to those of (-)-noradrenaline and (-)-adrenaline, mediated through beta1- and beta2-adrenoceptors respectively. The three agonists decreased ventricular monophasic action potential duration but prolonged the action potential plateau; beta3-adrenoceptor-selective agonists had no effect. (-)-CGP 12177 was the most potent, but (-)-noradrenaline the most efficacious; both agonists caused ventricular extra-systoles. Because only (-)-noradrenaline but not (-)-CGP 12177 elicited shortening of the refractory period, the mechanism of arrhythmias mediated through beta1- and putative beta4-adrenoceptors may be different.
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Affiliation(s)
- M D Lowe
- Department of Biochemistry, University of Cambridge, UK
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Hildick-Smith DJ, Lowe MD, Walsh JT, Ludman PF, Stephens NG, Schofield PM, Stone DL, Shapiro LM, Petch MC. Coronary angiography from the radial artery--experience, complications and limitations. Int J Cardiol 1998; 64:231-9. [PMID: 9672402 DOI: 10.1016/s0167-5273(98)00074-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIMS to assess the outcomes, complications and limitations of coronary angiography performed via percutaneous radial artery puncture. METHODS AND RESULTS two hundred and fifty patients underwent diagnostic coronary angiography from the radial artery, 182 (72.8%) of whom had contraindications to the femoral approach, for example due to peripheral vascular disease (n=85), therapeutic anticoagulation (29), or failed femoral approach (17). Procedural success in this high-risk population was achieved in 231 patients (92.4%). Principle reasons for failure were unsuccessful radial access (5) and arterial spasm (5). Procedure duration (SD) for an operator's first 20 cases compared with cases thereafter (min) was 47.7 (16.7) vs. 41.5 (14.6), P=0.0004; fluoroscopy time (min) 9.7 (7.1) vs. 6.6 (5.1), P=0.0001 and procedural success 89.6% vs. 94.1%, P=ns. Complications included two deaths associated temporally with catheterisation, three cases of arterial dissection without ischaemic sequelae and one transient ischaemic attack. CONCLUSIONS coronary angiography can be performed successfully from the radial artery, but this approach has limitations, which include the need to demonstrate dual palmar vascular supply, the prolonged learning phase, the procedural failure rate, patient discomfort and a demonstrable incidence of vascular and haemodynamic complications. We believe that radial coronary angiography should only be undertaken when there is a contraindication to the femoral approach.
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Abstract
Sotalol may induce torsade de pointes through cardiac action potential prolongation, but a proarrhythmic effect secondary to its beta blocking action has not been reported. A 54 year old man presented with symptoms of angina and presyncope, subsequently demonstrated to be associated with coronary spasm. Treatment with sotalol exacerbated his symptoms and resulted in recurrent polymorphic ventricular tachycardia with a pattern indistinguishable from that caused by a class III action. Following sotalol with-drawal polymorphic ventricular tachycardia resolved completely. Polymorphic ventricular tachycardia in patients treated with sotalol may therefore not always be the result of delayed repolarisation, but may be caused by beta adrenoceptor blockade.
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Affiliation(s)
- M D Lowe
- Department of Cardiology, Papworth Hospital, Cambridge, UK
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27
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Hildick-Smith DJ, Lowe MD, Newell SA, Schofield PM, Shapiro LM, Stone DL, Grace AA, Petch MC. Ventricular pacemaker upgrade: experience, complications and recommendations. Heart 1998; 79:383-7. [PMID: 9616348 PMCID: PMC1728671 DOI: 10.1136/hrt.79.4.383] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess outcomes of pacemaker upgrade from single chamber ventricular to dual chamber. DESIGN Retrospective analysis of patients undergoing the procedure. SETTING Specialist cardiothoracic unit. PATIENTS 44 patients (15 female, 29 male), mean (SD) age at upgrade 68.2 (12.9) years. INTERVENTIONS Upgrade of single chamber ventricular to dual chamber pacemaker. MAIN OUTCOME MEASURES Procedure duration and complications. RESULTS Principal indications for upgrade were pacemaker syndrome (17), "opportunistic"--that is, at elective generator replacement (8), heart failure (7), non-specific breathlessness/fatigue (7), and neurally mediated syncope (3). Mean (SD) upgrade procedure duration (82.9 (32.6) minutes) significantly exceeded mean VVI implantation duration (42.9 (13.3) minutes) and mean DDD implantation duration (56.6 (22.7) minutes) (both p < 0.01). Complications included pneumothorax (1), ventricular arrhythmia requiring cardioversion (2), protracted procedure (10), atrial lead repositioning within six weeks (8), haematoma evacuation (1), superficial infection (1), and admission to hospital with chest pain (1); 20 patients (45%) suffered one or more complications including four of the eight who underwent opportunistic upgrade. CONCLUSIONS Pacemaker upgrade takes longer and has a higher complication rate than either single or dual chamber pacemaker implantation. This suggests that the procedure should be performed by an experienced operator, and should be undertaken only if a firm indication exists. Patients with atrial activity should not be offered single chamber ventricular systems in the belief that the unit can be upgraded later if necessary at minimal risk.
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Hildick-Smith DJ, Ludman PF, Lowe MD, Stephens NG, Harcombe AA, Walsh JT, Stone DL, Shapiro LM, Schofield PM, Petch MC. Comparison of radial versus brachial approaches for diagnostic coronary angiography when the femoral approach is contraindicated. Am J Cardiol 1998; 81:770-2. [PMID: 9527090 DOI: 10.1016/s0002-9149(97)01013-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
One hundred patients with contraindications to the femoral approach were randomized to undergo diagnostic coronary angiography via percutaneous radial puncture or brachial artery cutdown. Procedure duration, fluoroscopy time, and total radiation dose were significantly less via the radial route, whereas procedural success, complication rates, and pain scores were comparable; we conclude that the radial technique should be the arm approach of choice for new trainees, although there will be occasions when radial access fails and a brachial approach is required.
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Affiliation(s)
- D J Hildick-Smith
- Department of Cardiology, Papworth Hospital, Cambridgeshire, United Kingdom
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29
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Affiliation(s)
- M D Lowe
- Cardiac Unit, Papworth Hospital, Cambridge, UK
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Ludman PF, Stephens NG, Harcombe A, Lowe MD, Shapiro LM, Schofield PM, Petch MC. Radial versus femoral approach for diagnostic coronary angiography in stable angina pectoris. Am J Cardiol 1997; 79:1239-41. [PMID: 9164893 DOI: 10.1016/s0002-9149(97)00089-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We compared coronary angiography of the radial artery using 6Fr catheters in 116 patients with that of the femoral artery in 100 case controls. We showed that transradial coronary angiography offers a useful alternative to the femoral route and can be performed without resorting to 5Fr catheters.
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Affiliation(s)
- P F Ludman
- Department of Cardiology, Papworth Hospital, Papworth Everard, United Kingdom
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Stewart AJ, Lowe MD. Knowledge and attitude of nurses on medical wards to defibrillation. J R Coll Physicians Lond 1994; 28:399-401. [PMID: 7807425 PMCID: PMC5401030] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We questioned 112 qualified nurses working on general medical wards about their resuscitation experience and knowledge of ECG interpretation and defibrillation. Although all but two of them had been formally trained in basic cardiopulmonary resuscitation (CPR) only 16 had received any training in the last six months. Seventy-five per cent of nurses were involved in CPR as first responders but only 18% had used a defibrillator during a cardiac arrest. Identification of ECG rhythms and practical knowledge about defibrillation was encouraging despite the lack of formal training in this field. Almost every one of the nurses would be willing to receive training in advanced cardiac life support. The responses to this inquiry suggest that nurses on medical wards are enthusiastic about advanced cardiac life support and already have some basic practical knowledge. Appropriate training (and retraining) of nursing staff should improve the outcome of resuscitation efforts on medical wards.
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Affiliation(s)
- A J Stewart
- Cardiac Department, St Thomas' Hospital, London
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Dewes HF, Lowe MD, McKay CE. An assessment of the copper status of dairy herds in the Waikato, Taranaki and Northland in spring and the effects of daily supplementation with copper sulphate. N Z Vet J 1990; 38:98-101. [PMID: 16031587 DOI: 10.1080/00480169.1990.35627] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The copper status of dairy herds in the Waikato, Taranaki and Northland regions between 1 August and 30 September was assessed by copper determinations made on composite sera from ten cows in each herd. Comparisons were made between two major groups categorised as as received and supplemented. In the latter, the cows received 2.0-6.0 g/day of copper sulphate orally from late gestation to the end of lactation. Mean copper values were determined from pastures in Taranaki and Northland and from pastures from three soil types in the Waikato. The lowest were in Northland (134.3 micromol/kg) and the highest in Taranaki (173.3 micromol/kg). Calculated dietary available copper levels showed the lowest were from pastures grown on organic soils in the Waikato. These soils also had high molybdenum levels. Serum copper values as received were lowest in Northland (7.30 micromol/l), and were marginal for both Taranaki (9.91 micromol/l) and the Waikato (9.93 micromol/l). The levels in supplemented herds were considerably higher, i.e. from the Waikato 11.7 micromol/l and from Taranaki 11.5 micromol/l. When liver and serum copper levels from paired samples were compared there was a reasonable correlation (r = 0.64) but the standard deviation approximated the mean liver copper level, i.e. 155 +/- 141 micromol/l.
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Affiliation(s)
- H F Dewes
- Hamilton Analytical Laboratory, PO Box 4136, Hamilton East
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Dewes HF, Lowe MD, Bydder EL. The detection and measurement of stray electrical leakages on dairy farms: effects on performance. N Z Vet J 1989; 37:117-21. [PMID: 16031538 DOI: 10.1080/00480169.1989.35578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sources of stray electrical leakage from Power Supply Authority alternating current (AC), fence energiser pulses and randomly generated pulses and spikes on 55 dairy farms in the Waikato area were identified between December 1986 and March 1988. The electrical measurements were made using a specifically designed voltmeter able to detect voltages between 0.1V and 1500V, from single voltage spikes of two microseconds or greater duration from direct current (DC) as well as 50 Hz AC. Ninety-five sources of stray voltage were identified, and 53 per cent of properties had more than one source of >0.5V. The major source was from electric fence energisers. Rotary platform parlours were among the commonest sources of random or transient voltage spikes. Leakage of AC into one or other of the components of the milk transport system such as vat, plate cooler, milk lift pump and milk line was common. Owners acknowledged the improvements in milk production, reproductive performance and growth rate of calves after reduction of the exposure of dairy cattle to stray electrical leakage. A representative summary of five case records helps define the range of improvements that may possibly be achieved.
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Affiliation(s)
- H F Dewes
- Hamilton Analytical Laboratory, PO Box 4136, Hamilton, New Zealand
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Abstract
A case of selenium poisoning was suspected following the administration of 325 micromol selenium a day as sodium selenate (25 mg Se) for five consecutive days. The main signs were confined to changes in the integument which were loss of hair from the mane and tail, disintegration of the skin of the anus, lips, prepuce and scrotum, and separation of the hooves from the coronary corium. Periodic analyses of blood, hair and hoof parings from the sole correlated strongly with blood and identified horn and hair as important additional routes of excretion.
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Affiliation(s)
- H F Dewes
- Hamilton Analytical Laboratory, Hamilton East
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Dewes HF, Lowe MD. Sodium requirements for grazing animals. N Z Vet J 1987; 35:19-20. [PMID: 16031328 DOI: 10.1080/00480169.1987.35368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dewes HF, Lowe MD. The enigma of zinc. N Z Vet J 1987; 35:16-7. [PMID: 16031326 DOI: 10.1080/00480169.1987.35366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
The sex attractant produced by adult females of the grass grub beetle Costelytra zealandica (White) has been isolated and identified as phenol. Field tests with phenol-water mixtures were attractive to male beetles in particular.
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Griffiths DD, Lowe MD. Dispensing Doctors. West J Med 1966. [DOI: 10.1136/bmj.2.5511.473-c] [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: 11/03/2022]
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