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Crowther G, Krishnan MS, Richardson J, Bowes R, Fitzpatrick A, Tayebjee MH. What training should psychiatrists have to interpret six- and 12-lead electrocardiograms? BJPsych Bull 2023; 47:352-356. [PMID: 36700251 PMCID: PMC10694687 DOI: 10.1192/bjb.2022.87] [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: 04/04/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 01/27/2023] Open
Abstract
To monitor for drug-related cardiac arrhythmias, psychiatrists regularly perform and interpret 12-lead (12L) and, increasingly often, six-lead (6L) electrocardiograms (ECGs). It is not known how training on this complex skill is updated or how well psychiatrists can interpret relevant arrhythmias on either device.We conducted an online survey and ECG interpretation test of cardiac rhythms relevant to psychiatrists.A total of 183 prescribers took part; 75% did not regularly update their ECG interpretation skills, and only 22% felt confident in interpreting ECGs. Most participants were able to recognise normal ECGs. For both 6L and 12L ECGs, the majority of participants were able to recognise abnormal ECGs, but fewer than 50% were able to correctly identify relevant arrhythmias (complete heart block and long QTc). A small number prescribed in the presence of potentially fatal arrhythmias. These findings suggest a need for mandatory ECG interpretation training to improve safe prescribing practice.
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Affiliation(s)
- George Crowther
- Leeds and York Partnership NHS Foundation Trust, UK
- University of Leeds, UK
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2
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Javid R, Wassef N, Wheatcroft SB, Tayebjee MH. Coronary Guidewires in Temporary Cardiac Pacing and Assessment of Myocardial Viability: Current Perspectives and Future Directions. J Clin Med 2023; 12:6976. [PMID: 38002591 PMCID: PMC10672001 DOI: 10.3390/jcm12226976] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/14/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Intracoronary guidewires used in percutaneous coronary intervention can also be configured to provide temporary ventricular pacing. Trans coronary electrophysiological parameters recorded by employing coronary guidewires may have a potential role in assessing myocardial viability and could provide a means to make an immediate on-table decision about revascularisation. To date, some small studies have demonstrated the safety of this technique in temporary cardiac pacing, but further research is required to refine this approach and establish its clinical utility in myocardial viability assessment. In this review we discuss the potential role of trans coronary electrophysiology in the assessment of myocardial viability.
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Affiliation(s)
- Rabeia Javid
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.J.); (S.B.W.)
- Leeds General Infirmary, Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK;
| | - Nancy Wassef
- Leeds General Infirmary, Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK;
| | - Stephen B. Wheatcroft
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.J.); (S.B.W.)
- Leeds General Infirmary, Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK;
| | - Muzahir H. Tayebjee
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.J.); (S.B.W.)
- Leeds General Infirmary, Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK;
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3
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Slater TA, Tayebjee MH. Intensive screening for atrial fibrillation may not prevent recurrent stroke: a review of the current guidelines. Eur J Prev Cardiol 2023:zwad302. [PMID: 37715963 DOI: 10.1093/eurjpc/zwad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/04/2023] [Accepted: 09/15/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Thomas A Slater
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Muzahir H Tayebjee
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Leeds, United Kingdom
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4
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Gupta D, Ding WY, Calvert P, Williams E, Das M, Tovmassian L, Tayebjee MH, Haywood G, Martin CA, Rajappan K, Bates MGD, Temple IP, Reichlin T, Chen Z, Balasubramaniam RN, Ronayne C, Clarkson N, Morgan M, Barton J, Kemp I, Mahida S, Sticherling C. Cryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter. Heart 2023; 109:364-371. [PMID: 36396438 DOI: 10.1136/heartjnl-2022-321729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We aimed to compare cryoballoon pulmonary vein isolation (PVI) with standard radiofrequency cavotricuspid isthmus (CTI) ablation as first-line treatment for typical atrial flutter (AFL). METHODS Cryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter was an international, multicentre, open with blinded assessment trial. Patients with CTI-dependent AFL and no documented atrial fibrillation (AF) were randomised to either cryoballoon PVI alone or radiofrequency CTI ablation. Primary efficacy outcome was time to first recurrence of sustained (>30 s) symptomatic atrial arrhythmia (AF/AFL/atrial tachycardia) at 12 months as assessed by continuous monitoring with an implantable loop recorder. Primary safety outcome was a composite of death, stroke, tamponade requiring drainage, atrio-oesophageal fistula, pacemaker implantation, serious vascular complications or persistent phrenic nerve palsy. RESULTS Trial recruitment was halted at 113 of the target 130 patients because of the SARS-CoV-2 pandemic (PVI, n=59; CTI ablation, n=54). Median age was 66 (IQR 61-71) years, with 98 (86.7%) men. At 12 months, the primary outcome occurred in 11 (18.6%) patients in the PVI group and 9 (16.7%) patients in the CTI group. There was no significant difference in the primary efficacy outcome between the groups (HR 1.11, 95% CI 0.46 to 2.67). AFL recurred in six (10.2%) patients in the PVI arm and one (1.9%) patient in the CTI arm (p=0.116). Time to occurrence of AF of ≥2 min was significantly reduced with cryoballoon PVI (HR 0.46, 95% CI 0.25 to 0.85). The composite safety outcome occurred in four patients in the PVI arm and three patients in the CTI arm (p=1.000). CONCLUSION Cryoballoon PVI as first-line treatment for AFL is equally effective compared with standard CTI ablation for preventing recurrence of atrial arrhythmia and better at preventing new-onset AF. TRIAL REGISTRATION NUMBER NCT03401099.
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Affiliation(s)
- Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK .,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Wern Yew Ding
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Peter Calvert
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Emmanuel Williams
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Moloy Das
- Newcastle Upon Tyne Hospital NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Lilith Tovmassian
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Muzahir H Tayebjee
- Department of Cardiology, Leeds Teaching Hospital NHS Foundation Trust, Leeds, UK
| | - Guy Haywood
- Department of Cardiology, University Hospitals Plymouth NHS Foundation Trust, Plymouth, UK
| | - Claire A Martin
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Kim Rajappan
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Matthew G D Bates
- Department of Cardiology, South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, UK
| | - Ian Peter Temple
- Department of Cardiology, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Zhong Chen
- Department of Cardiology, Ashford and St Peter's Hospital NHS Foundation Trust, Surrey, UK
| | - Richard N Balasubramaniam
- Department of Cardiology, Royal Bournemouth and Christchurch Hospital NHS Foundation Trust, Bournemouth, UK
| | - Christina Ronayne
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Nichola Clarkson
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Maureen Morgan
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Janet Barton
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Ian Kemp
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Saagar Mahida
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
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5
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Crowther G, Ahmed N, Kasa D, Goff Z, Tayebjee MH. Cardiac monitoring in memory clinics: national survey of UK practice. BJPsych Bull 2023; 47:11-16. [PMID: 34823623 PMCID: PMC10028537 DOI: 10.1192/bjb.2021.108] [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] [Indexed: 02/04/2023] Open
Abstract
AIMS AND METHOD People diagnosed with dementia are often started on acetylcholinesterase inhibitors (AChEIs). As AChEIs can be associated with cardiac side-effects, an electrocardiogram (ECG) is sometimes requested before treatment. Previous work has suggested there is little consensus as to when or how ECGs should be obtained. This can create inconsistent practice, with patient safety, economic and practical repercussions. We surveyed 305 UK memory clinic practitioners about prescribing practice. RESULTS More than 84% of respondents completed a pulse and cardiac history before prescribing AChEIs. Opinion was divided as to who should fund and conduct ECGs. It was believed that obtaining an ECG causes patients inconvenience and delays treatment. Despite regularly interpreting ECGs, 76% of respondents did not update this clinical skill regularly. CLINICAL IMPLICATIONS The variation in practice observed has service-level and patient implications and raises potential patient safety concerns. Implementing national guidelines or seeking novel ways of conducting cardiac monitoring could help standardise practice.
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Affiliation(s)
- George Crowther
- Leeds and York Partnership NHS Foundation Trust, UK
- University of Leeds, UK
| | | | - Deepa Kasa
- Leeds and York Partnership NHS Foundation Trust, UK
| | - Zoe Goff
- Leeds and York Partnership NHS Foundation Trust, UK
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6
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Saunderson CED, Hogarth AJ, Papaspyros S, Tingerides C, Tayebjee MH. An unusual cause of a haemothorax following pacemaker implantation: A case report. Eur Heart J Case Rep 2022; 6:ytac185. [PMID: 35592745 PMCID: PMC9113347 DOI: 10.1093/ehjcr/ytac185] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/18/2022] [Accepted: 04/28/2022] [Indexed: 11/20/2022]
Abstract
Background Haemothoraces are a reported but extremely rare complication of pacemaker implantation. Haemothoraces can be a consequence of lead perforation through the right ventricle (RV) and pericardium into the pleural space, direct lung or vascular injury during access. Case summary A 72-year-old woman presented 24 h after a pacemaker implantation with chest pain and shortness of breath. Computed tomography of the chest confirmed perforation of the RV lead into the left pleural cavity with a large left sided haemothorax. Following percutaneous drainage of the left sided haemothorax, the patient became haemodynamically unstable necessitating emergent sternotomy. During surgery, the extra-cardiac portion of the pacing lead was cut, the RV repaired and a large haematoma evacuated from the left pleural space. Despite this, the patient remained hypotensive, and further exploration showed a bleeding intercostal artery that had been lacerated by the pacing lead. This was treated by electrocautery, and the patient’s haemodynamic status improved. The RV lead remnant was removed transvenously via the subclavian vein, and the patient was left with a single chamber atrial pacemaker. Discussion Prompt recognition of RV lead perforation and its associated sequalae, often utilising multi-modality imaging, is vital to enable transfer to a centre with cardiac surgical expertise. In this case, the perforating RV lead lacerated an intercostal artery, and this was only identified at the time of surgery. In order to minimize the risk of perforation, multiple fluoroscopic views should be used, and care should be taken during helix deployment.
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Affiliation(s)
- Christopher E. D. Saunderson
- Department of Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew J. Hogarth
- Department of Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sotiris Papaspyros
- Department of Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Costa Tingerides
- Department of Diagnostic and Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Muzahir H. Tayebjee
- Department of Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Department of Cardiology, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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7
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Michaels J, Parfrey S, Mozid AM, Veerasamy M, Bulluck H, Tayebjee MH. Incidence and Clinical Predictors of Non-Obstructive Coronary Arteries in Patients With Suspected Non-ST Elevation Myocardial Infarction Undergoing Invasive Coronary Angiography. Heart Lung Circ 2022; 31:e115-e116. [PMID: 35501245 DOI: 10.1016/j.hlc.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/08/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Joshua Michaels
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Shane Parfrey
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Abdul M Mozid
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Murugapathy Veerasamy
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Heerajnarain Bulluck
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Muzahir H Tayebjee
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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8
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Tayebjee MH, Jeilan M, Bonny A. The State of Cardiac Electrophysiology in Africa: Ongoing Efforts and Future Directions. JACC Clin Electrophysiol 2021; 7:1328-1330. [PMID: 34674840 DOI: 10.1016/j.jacep.2021.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Muzahir H Tayebjee
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Leeds, United Kingdom
| | - Mohamed Jeilan
- Department of Cardiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Aime Bonny
- Department of Internal Medicine, Gyneco-Obstetric and Pediatric Teaching Hospital/University of Douala, Doula, Cameroon; Department of Cardiology, Arrhythmia Unit, Hopital Le Raincy-Montfermeil, Montfermeil, France.
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9
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Azram M, Ahmed N, Leese L, Brigham M, Bowes R, Wheatcroft SB, Ngantcha M, Stegemann B, Crowther G, Tayebjee MH. Clinical validation and evaluation of a novel six-lead handheld electrocardiogram recorder compared to the 12-lead electrocardiogram in unselected cardiology patients (EVALECG Cardio). Eur Heart J Digit Health 2021; 2:643-648. [PMID: 36713105 PMCID: PMC9707882 DOI: 10.1093/ehjdh/ztab083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/01/2021] [Accepted: 09/20/2021] [Indexed: 02/01/2023]
Abstract
Aims Handheld electrocardiogram (ECG) monitors are increasingly used by both healthcare workers and patients to diagnose cardiac arrhythmias. There is a lack of studies validating the use of handheld devices against the standard 12-lead ECG. The Kardia 6L is a novel handheld ECG monitor which can produce a 6-lead ECG. In this study, we compare the 6L ECG against the 12-lead ECG. Methods and results A prospective study consisting of unselected cardiac inpatients and outpatients at Leeds Teaching Hospital NHS Trust. All participants had a 12- and 6-lead ECGs. All ECG parameters were analysed by using a standard method template for consistency between independent observers. Electrocardiograms from the recorders were compared by the following statistical methods: linear regression, Bland-Altman, receiver operator curve, and kappa analysis. There were 1015 patients recruited. The mean differences between recorders were small for PR, QRS, cardiac axis, with receiver operator analysis area under the curve (AUC) of >80%. Mean differences for QT and QTc (between recorders) were also small, with AUCs for QT leads of >75% and AUCs for QTc leads of >60%. Key findings from Bland-Altman analysis demonstrate overall an acceptable agreement with few outliers instances (<6%, Bland-Altman analysis). Conclusion Several parameters recorded by the Kardia 6L (QT interval in all six leads, rhythm detection, PR interval, QRS duration, and cardiac axis) perform closely to the gold standard 12-lead ECG. However, that consistency weakens for left ventricular hypertrophy, QRS amplitudes (Lead I and AVL), and ischaemic changes.
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Affiliation(s)
- Mohammad Azram
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - Noura Ahmed
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, UK,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Lucy Leese
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - Matthew Brigham
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - Robert Bowes
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - Stephen B Wheatcroft
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, UK,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Marcus Ngantcha
- Homeland Heart Center/Douala Cardiovascular Research Center, Douala, Cameroon
| | | | - George Crowther
- Leeds and York Partnership NHS Foundation Trust and Leeds Institute of Health Sciences, Univeristy of Leeds, Leeds, UK
| | - Muzahir H Tayebjee
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, UK,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK,Corresponding author. Tel: +441133926619,
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10
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Rahunathan N, Barrett L, Leese L, Brigham M, McGinley M, Simms AD, Tayebjee MH. Patients perspective on the effect of COVID-19 on heart failure admissions. Int J Clin Pract 2021; 75:e14119. [PMID: 33887874 PMCID: PMC8250090 DOI: 10.1111/ijcp.14119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/24/2021] [Indexed: 01/25/2023] Open
Affiliation(s)
| | - Laura Barrett
- Department of CardiologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Lucy Leese
- Department of CardiologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Matthew Brigham
- Department of CardiologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Melanie McGinley
- Department of CardiologyLeeds Teaching Hospitals NHS TrustLeedsUK
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11
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Mercer B, Leese L, Ahmed N, Holden AV, Tayebjee MH. A simple adaptation of a handheld ECG recorder to obtain chest lead equivalents. J Electrocardiol 2020; 63:54-56. [PMID: 33099175 PMCID: PMC7563578 DOI: 10.1016/j.jelectrocard.2020.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/29/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022]
Abstract
Hand held ECG recorders are transforming the way we detect and diagnose heart rhythm disorders. The Kardia 6 L was launched in 2019 to detect and diagnose heart rhythm disorders recording a six lead (limb lead) ECG. Recording and analysis of precordial leads are currently not supported by the Kardia 6 L. In this study we aim to assess if reliable chest lead data can be obtained using a simple modification to the recording system.
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Affiliation(s)
- B Mercer
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - L Leese
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - N Ahmed
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - A V Holden
- Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - M H Tayebjee
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK.
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12
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Bonny A, Talle MA, Ngantcha M, Tayebjee MH. Conflicting evidence on the efficacy of hydroxychloroquine and azithromycin as the early treatment of COVID-19. Comment on "Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France". Travel Med Infect Dis 2020; 37:101861. [PMID: 32889105 PMCID: PMC7462460 DOI: 10.1016/j.tmaid.2020.101861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/19/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Aimé Bonny
- Faculty of medicine and pharmaceutical sciences, University of Douala, Cameroon.
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13
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Rwebembera J, Jeilan M, Ajijola OA, Talle M, Sani MU, Karaye KM, Yuyun MF, Nel G, Akinyi L, Subahi S, Aboulmaaty M, Sogade F, Aoudia Y, Mbakwem A, Tantchou C, Salim M, Tayebjee MH, Poku JW, Vezi B, Kaviraj B, Ngantcha M, Chin A, Bonny A. Cardiac Pacing Training in Africa. J Am Coll Cardiol 2020; 76:465-472. [DOI: 10.1016/j.jacc.2020.04.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 10/23/2022]
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14
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Nadar SK, Tayebjee MH, Stowasser M, Byrd JB. Managing hypertension during the COVID-19 pandemic. J Hum Hypertens 2020; 34:415-417. [PMID: 32409727 PMCID: PMC7224587 DOI: 10.1038/s41371-020-0356-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Sunil K Nadar
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.
| | | | - Michael Stowasser
- Endocrine Hypertension research center, University of Queensland, Princess Alexandra hospital, Brisbane, Australia
| | - James Brian Byrd
- Department of Internal Medicine, University of Michigan Medical Schooll, Ann Arbor, MI, USA
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15
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Begg GA, Swoboda PP, Karim R, Oesterlein T, Rhode K, Holden AV, Greenwood JP, Shantsila E, Lip GYH, Plein S, Tayebjee MH. Imaging, biomarker and invasive assessment of diffuse left ventricular myocardial fibrosis in atrial fibrillation. J Cardiovasc Magn Reson 2020; 22:13. [PMID: 32036784 PMCID: PMC7008543 DOI: 10.1186/s12968-020-0603-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 01/15/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Using cardiovascular magnetic resonance imaging (CMR), it is possible to detect diffuse fibrosis of the left ventricle (LV) in patients with atrial fibrillation (AF), which may be independently associated with recurrence of AF after ablation. By conducting CMR, clinical, electrophysiology and biomarker assessment we planned to investigate LV myocardial fibrosis in patients undergoing AF ablation. METHODS LV fibrosis was assessed by T1 mapping in 31 patients undergoing percutaneous ablation for AF. Galectin-3, coronary sinus type I collagen C terminal telopeptide (ICTP), and type III procollagen N terminal peptide were measured with ELISA. Comparison was made between groups above and below the median for LV extracellular volume fraction (ECV), followed by regression analysis. RESULTS On linear regression analysis LV ECV had significant associations with invasive left atrial pressure (Beta 0.49, P = 0.008) and coronary sinus ICTP (Beta 0.75, P < 0.001), which remained significant on multivariable regression. CONCLUSION LV fibrosis in patients with AF is associated with left atrial pressure and invasively measured levels of ICTP turnover biomarker.
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Affiliation(s)
- Gordon A. Begg
- Department of Cardiology, Leeds General Infirmary, X39 Cardiology Offices, Great George St, Leeds, LS1 3EX UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Peter P. Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Rashed Karim
- Department of Biomedical Engineering, King’s College, London, UK
| | - Tobias Oesterlein
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany
| | - Kawal Rhode
- Department of Biomedical Engineering, King’s College, London, UK
| | - Arun V. Holden
- MCRC and School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT UK
| | - John P. Greenwood
- Department of Cardiology, Leeds General Infirmary, X39 Cardiology Offices, Great George St, Leeds, LS1 3EX UK
| | - Eduard Shantsila
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Gregory Y. H. Lip
- University of Liverpool, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sven Plein
- Department of Cardiology, Leeds General Infirmary, X39 Cardiology Offices, Great George St, Leeds, LS1 3EX UK
| | - Muzahir H. Tayebjee
- Department of Cardiology, Leeds General Infirmary, X39 Cardiology Offices, Great George St, Leeds, LS1 3EX UK
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16
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Holden AV, Begg GA, Bounford K, Stegemann B, Tayebjee MH. Phase Entrainment of Induced Ventricular Fibrillation: A Human Feasibility and Proof of Concept Study. J Atr Fibrillation 2019; 12:2217. [PMID: 32435345 DOI: 10.4022/jafib.2217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/19/2019] [Accepted: 09/21/2019] [Indexed: 11/10/2022]
Abstract
Cardioversion and defibrillation by a single high energy shock applied by myocardial or body surface electrodes is painful, causes long term tissue damage, and is associated with worsening long term outcomes, but is almost always required for treatment of ventricular fibrillation . As a initial step towards developing methods that can terminate ventricular arrhythmias painlessly, we aim to determine if pacing stimuli at a rate of 5/s applied via an implantable cardiac defibrillator (ICD) can modify human ventricular fibrillation. In 8 patients undergoing defibrillation testing of a new/exchanged intracardiac defibrillator, five seconds of pacing at five stimuli per second was applied during the 10-20 seconds of induced ventricular fibrillation before the defibrillation shock was automatically applied, and the cardiac electrograms recorded and analyzed. The high frequency pacing did not entrain the ventricular fibrillation, but altered the dominant frequency in all 8 patients, and modulated the phase computed via the Hilbert Transform, in four of the patients. In this pilot study we demonstrate that high frequency pacing applied via ICD electrodes during VF can alter the dominant frequency and modulate the probability density of the phase of the electrogram of the ventricular fibrillation.
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Affiliation(s)
- Arun V Holden
- School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT; UK
| | - Gordon A Begg
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Katrina Bounford
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Berthold Stegemann
- Medtronic Plc, Bakken Research Center, Endepolsdomein 5, 6229 GW Maastricht, The Netherlands
| | - Muzahir H Tayebjee
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
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17
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O’Neill J, Bounford K, Anstey A, D’Silva J, Clark L, Plein S, Tayebjee MH. P wave indices, heart rate variability and anthropometry in a healthy South Asian population. PLoS One 2019; 14:e0220662. [PMID: 31442233 PMCID: PMC6707586 DOI: 10.1371/journal.pone.0220662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 07/19/2019] [Indexed: 12/19/2022] Open
Abstract
Background South Asians have a low prevalence of atrial fibrillation (AF) in comparison with White Europeans despite a higher burden of hypertension, diabetes mellitus and coronary artery disease. The reason for this disparity is unclear but may relate to electrophysiological or structural differences within the atria or variations in autonomic function. We aimed to assess these areas using a range of non-invasive cardiac investigations. Methods A prospective cohort study was performed on 200 South Asian and 200 Caucasian healthy volunteers aged 18–40 years. All subjects underwent electrocardiography (ECG), echocardiography and anthropometric measurements. Eighty subjects in each cohort underwent 24 hour ambulatory ECG and fifty subjects in each cohort underwent exercise testing. Results Compared with White Europeans, South Asians were of a smaller height with lower lean body mass and smaller left atrial size. They had reduced P wave dispersion and P wave terminal force in lead V1. South Asians had a lower burden of supraventricular ectopy. They had a higher mean heart rate and South Asian males had lower heart rate variability, suggestive of sympathetic predominance. Exercise capacity was lower in South Asians. Conclusions South Asians have differences in left atrial size, P wave indices, burden of supraventricular ectopy, heart rate, heart rate variability and anthropometric measurements. These differences may relate to variations in atrial morphology, atrial electrophysiology and autonomic function and might help to explain why South Asians are less susceptible to developing AF.
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Affiliation(s)
- James O’Neill
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
- * E-mail: james.o’
| | - Katrina Bounford
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Alice Anstey
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Jesvita D’Silva
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Lisa Clark
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Muzahir H. Tayebjee
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
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18
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Elsisi IFHA, Tan FSC, Nadar SK, Tayebjee MH. Ventricular interdependence in hypertension: fact or fiction? J Hum Hypertens 2019; 33:489-490. [DOI: 10.1038/s41371-019-0202-2] [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] [Received: 03/26/2019] [Accepted: 04/03/2019] [Indexed: 11/10/2022]
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19
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Marcinkevics R, O'Neill J, Law H, Pervolaraki E, Hogarth A, Russell C, Stegemann B, Holden AV, Tayebjee MH. Multichannel electrocardiogram diagnostics for the diagnosis of arrhythmogenic right ventricular dysplasia. Europace 2019; 20:f13-f19. [PMID: 29016773 DOI: 10.1093/europace/eux124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/12/2017] [Indexed: 11/14/2022] Open
Abstract
Aims The identification of arrhythmogenic right ventricular dysplasia (ARVD) from 12-channel standard electrocardiogram (ECG) is challenging. High density ECG data may identify lead locations and criteria with a higher sensitivity. Methods and results Eighty-channel ECG recording from patients diagnosed with ARVD and controls were quantified by magnitude and integral measures of QRS and T waves and by a measure (the average silhouette width) of differences in the shapes of the normalized ECG cycles. The channels with the best separability between ARVD patients and controls were near the right ventricular wall, at the third intercostal space. These channels showed pronounced differences in P waves compared to controls as well as the expected differences in QRS and T waves. Conclusion Multichannel recordings, as in body surface mapping, add little to the reliability of diagnosing ARVD from ECGs. However, repositioning ECG electrodes to a high anterior position can improve the identification of ECG variations in ARVD. Additionally, increased P wave amplitude appears to be associated with ARVD.
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Affiliation(s)
| | - James O'Neill
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds LS1?3EX, UK
| | - Hannah Law
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds LS1?3EX, UK
| | | | - Andrew Hogarth
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds LS1?3EX, UK
| | - Craig Russell
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds LS1?3EX, UK
| | | | - Arun V Holden
- School of Biomedical Sciences, University of Leeds, Leeds LS2?9JT, UK
| | - Muzahir H Tayebjee
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds LS1?3EX, UK
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20
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Begg GA, O’Neill J, Sohaib A, McLean A, Pepper CB, Graham LN, Hogarth AJ, Page SP, Gillott RG, Hill N, Walshaw J, Schilling RJ, Kanagaratnam P, Tayebjee MH. Multicentre randomised trial comparing contact force with electrical coupling index in atrial flutter ablation (VERISMART trial). PLoS One 2019; 14:e0212903. [PMID: 30943196 PMCID: PMC6447159 DOI: 10.1371/journal.pone.0212903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 02/09/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Electrical coupling index (ECI) and contact force (CF) have been developed to aid lesion formation during catheter ablation. ECI measures tissue impedance and capacitance whilst CF measures direct contact. The aim was to determine whether the presence of catheter / tissue interaction information, such as ECI and CF, reduce time to achieve bidirectional cavotricuspid isthmus block during atrial flutter (AFL) ablation. Methods Patients with paroxysmal or persistent AFL were randomised to CF visible (range 5-40g), CF not visible, ECI visible (change of 12%) or ECI not visible. Follow-up occurred at 3 and 6 months and included a 7 day ECG recording. The primary endpoint was time to bidirectional cavotricuspid isthmus block. Results 114 patients were randomised, 16 were excluded. Time to bidirectional block was significantly shorter when ECI was visible (median 30.0 mins (IQR 31) to median 10.5mins (IQR 12) p 0.023) versus ECI not visible. There was a trend towards a shorter time to bidirectional block when CF was visible. Higher force was applied when CF was visible (median 9.03g (IQR 7.4) vs. 11.3g (5.5) p 0.017). There was no difference in the acute recurrence of conduction between groups. The complication rate was 2%, AFL recurrence was 1.1% and at 6 month follow-up, 12% had atrial fibrillation. Conclusion The use of tissue contact information during AFL ablation was associated with reduced time taken to achieve bidirectional block when ECI was visible. Contact force data improved contact when visible with a trend towards a reduction in the procedural endpoint. ClinicalTrials.gov trial identifier: NCT02490033.
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Affiliation(s)
- Gordon A. Begg
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - James O’Neill
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Afzal Sohaib
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Ailsa McLean
- Department of Cardiology, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United Kingdom
| | - Chris B. Pepper
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Lee N. Graham
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Andrew J. Hogarth
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Stephen P. Page
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Richard G. Gillott
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Nicola Hill
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Jacqueline Walshaw
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Richard J. Schilling
- Department of Cardiology, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United Kingdom
| | - Prapa Kanagaratnam
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Muzahir H. Tayebjee
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
- * E-mail:
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21
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O'Neill J, Jegodzinski L, Tayebjee MH. Incidence of subclinical atrial fibrillation in a South Asian population. Pacing Clin Electrophysiol 2018; 41:1600-1605. [DOI: 10.1111/pace.13516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/05/2018] [Accepted: 09/21/2018] [Indexed: 11/28/2022]
Affiliation(s)
- James O'Neill
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary; Leeds UK
| | | | - Muzahir H. Tayebjee
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary; Leeds UK
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22
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O'Neill J, Swoboda PP, Plein S, Tayebjee MH. Left atrial size and function in a South Asian population and their potential influence on the risk of atrial fibrillation. Clin Cardiol 2018; 41:1379-1385. [PMID: 30144123 DOI: 10.1002/clc.23064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND South Asians have a low prevalence of atrial fibrillation (AF) compared with Caucasians despite having a higher prevalence of conventional risk factors for the arrhythmia. The reason for this disparity is uncertain but may be due to ethnic differences in atrial morphology. This study examines the association between ethnicity and left atrial (LA) size and function in South Asian and Caucasian subjects using the reference technique of cardiovascular magnetic resonance imaging (MRI). HYPOTHESIS South Asians have smaller LA size and therefore increased LA function. METHODS Retrospective case-control study of 60 South Asian and 60 Caucasian patients who had undergone a clinically indicated MRI between April 2010 and October 2017 and had been found to have a structurally normal heart. LA and left ventricular (LV) volume and function were assessed and compared between the ethnicities. RESULTS In comparison with Caucasians, South Asians had significantly lower minimum (27.7 ± 11.1 mL vs 34.9 ± 12.3 mL, P = 0.002) and maximum LA volumes (64.7 ± 21.1 mL vs 80.9 ± 22.5 mL, P < 0.001), lower LV end-diastolic volume (P < 0.001), lower LV stroke volume (P < 0.001), and lower LV mass (P = 0.022) and these values remained significant after correcting for body surface area. Further analysis revealed that LA volume was independently associated with South Asian ethnicity. There was no difference in LA function between the ethnic groups. CONCLUSIONS South Asians have reduced LA volumes and a proportionally smaller heart size in comparison to Caucasians. Smaller LA size may protect against the development of AF by reducing the risk of reentrant circuit formation and atrial fibrosis development.
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Affiliation(s)
- James O'Neill
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Muzahir H Tayebjee
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
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23
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Kim MY, Sikkel MB, Hunter RJ, Haywood GA, Tomlinson DR, Tayebjee MH, Ali RL, Cantwell CD, Gonna H, Sandler BC, Lim E, Furniss G, Panagopoulos D, Begg G, Dhillon G, Hill NJ, O'Neill J, Francis DP, Lim PB, Peters NS, Linton NWF, Kanagaratnam P. A novel approach to mapping the atrial ganglionated plexus network by generating a distribution probability atlas. J Cardiovasc Electrophysiol 2018; 29:1624-1634. [PMID: 30168232 PMCID: PMC6369684 DOI: 10.1111/jce.13723] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 05/21/2018] [Revised: 08/16/2018] [Accepted: 08/23/2018] [Indexed: 11/27/2022]
Abstract
Introduction The ganglionated plexuses (GPs) of the intrinsic cardiac autonomic system are implicated in arrhythmogenesis. GP localization by stimulation of the epicardial fat pads to produce atrioventricular dissociating (AVD) effects is well described. We determined the anatomical distribution of the left atrial GPs that influence atrioventricular (AV) dissociation. Methods and Results High frequency stimulation was delivered through a Smart‐Touch catheter in the left atrium of patients undergoing atrial fibrillation (AF) ablation. Three dimensional locations of points tested throughout the entire chamber were recorded on the CARTO™ system. Impact on the AV conduction was categorized as ventricular asystole, bradycardia, or no effect. CARTO maps were exported, registered, and transformed onto a reference left atrial geometry using a custom software, enabling data from multiple patients to be overlaid. In 28 patients, 2108 locations were tested and 283 sites (13%) demonstrated (AVD‐GP) effects. There were 10 AVD‐GPs (interquartile range, 11.5) per patient. Eighty percent (226) produced asystole and 20% (57) showed bradycardia. The distribution of the two groups was very similar. Highest probability of AVD‐GPs (>20%) was identified in: inferoseptal portion (41%) and right inferior pulmonary vein base (30%) of the posterior wall, right superior pulmonary vein antrum (31%). Conclusion It is feasible to map the entire left atrium for AVD‐GPs before AF ablation. Aggregated data from multiple patients, producing a distribution probability atlas of AVD‐GPs, identified three regions with a higher likelihood for finding AVD‐GPs and these matched the histological descriptions. This approach could be used to better characterize the autonomic network.
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Affiliation(s)
- Min-Young Kim
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Markus B Sikkel
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Ross J Hunter
- Department of Cardiology, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Guy A Haywood
- Department of Cardiology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - David R Tomlinson
- Department of Cardiology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Muzahir H Tayebjee
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rheeda L Ali
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Chris D Cantwell
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Hanney Gonna
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Belinda C Sandler
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Elaine Lim
- Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Guy Furniss
- Department of Cardiology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Dimitrios Panagopoulos
- Department of Cardiology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Gordon Begg
- Department of Cardiology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Gurpreet Dhillon
- Department of Cardiology, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Nicola J Hill
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James O'Neill
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Darrel P Francis
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Phang Boon Lim
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Nicholas S Peters
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Nick W F Linton
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Prapa Kanagaratnam
- Myocardial Function Section, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK.,Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
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24
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Begg GA, Karim R, Oesterlein T, Graham LN, Hogarth AJ, Page SP, Pepper CB, Rhode K, Lip GYH, Holden AV, Plein S, Tayebjee MH. Left atrial voltage, circulating biomarkers of fibrosis, and atrial fibrillation ablation. A prospective cohort study. PLoS One 2018; 13:e0189936. [PMID: 29293545 PMCID: PMC5749720 DOI: 10.1371/journal.pone.0189936] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 12/05/2017] [Indexed: 12/30/2022] Open
Abstract
Aims To test the ability of four circulating biomarkers of fibrosis, and of low left atrial voltage, to predict recurrence of atrial fibrillation after catheter ablation. Background Circulating biomarkers potentially may be used to improve patient selection for atrial fibrillation ablation. Low voltage areas in the left atrium predict arrhythmia recurrence when mapped in sinus rhythm. This study tested type III procollagen N terminal peptide (PIIINP), galectin-3 (gal-3), fibroblast growth factor 23 (FGF-23), and type I collagen C terminal telopeptide (ICTP), and whether low voltage areas in the left atrium predicted atrial fibrillation recurrence, irrespective of the rhythm during mapping. Methods 92 atrial fibrillation ablation patients were studied. Biomarker levels in peripheral and intra-cardiac blood were measured with enzyme-linked immunosorbent assay. Low voltage (<0.5mV) was expressed as a proportion of the mapped left atrial surface area. Follow-up was one year. The primary endpoint was recurrence of arrhythmia. The secondary endpoint was a composite of recurrence despite two procedures, or after one procedure if no second procedure was undertaken. Results The biomarkers were not predictive of either endpoint. After multivariate Cox regression analysis, high proportion of low voltage area in the left atrium was found to predict the primary endpoint in sinus rhythm mapping (hazard ratio 4.323, 95% confidence interval 1.337–13.982, p = 0.014) and atrial fibrillation mapping (hazard ratio 5.195, 95% confidence interval 1.032–26.141, p = 0.046). This effect was also apparent for the secondary endpoint. Conclusion The studied biomarkers do not predict arrhythmia recurrence after catheter ablation. Left atrial voltage is an independent predictor of recurrence, whether the left atrium is mapped in atrial fibrillation or sinus rhythm.
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Affiliation(s)
- Gordon A Begg
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Rashed Karim
- Department of Biomedical Engineering, King's College, London, United Kingdom
| | - Tobias Oesterlein
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Lee N Graham
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Andrew J Hogarth
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Stephen P Page
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | | | - Kawal Rhode
- Department of Biomedical Engineering, King's College, London, United Kingdom
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, United Kingdom.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Arun V Holden
- School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Muzahir H Tayebjee
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
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O'Neill J, Hogarth AJ, Pearson I, Law H, Bowes R, Kidambi A, Wheatcroft S, Sivananthan UM, Tayebjee MH. Transcoronary pacing to assess myocardial viability prior to percutaneous coronary intervention: Pilot study to assess feasibility. Catheter Cardiovasc Interv 2017; 92:269-273. [DOI: 10.1002/ccd.27349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/23/2017] [Accepted: 08/31/2017] [Indexed: 11/09/2022]
Affiliation(s)
- James O'Neill
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - Andrew J. Hogarth
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - Ian Pearson
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - Hannah Law
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - Robert Bowes
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - Ananth Kidambi
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - Stephen Wheatcroft
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - U. Mohanaraj Sivananthan
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - Muzahir H. Tayebjee
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
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O'Neill J, Hogarth AJ, Pearson I, Kidambi A, Sivananthan UM, Tayebjee MH. 91Trans-coronary pacing to assess myocardial viability prior to percutaneous coronary intervention. Europace 2017. [DOI: 10.1093/europace/eux283.086] [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: 11/15/2022] Open
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Martsinkevich R, Stegemann B, Holden AV, Tayebjee MH. 89Differences in right and left atrial structure and electrophysiology in ARVD. Europace 2017. [DOI: 10.1093/europace/eux283.084] [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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Begg GA, Karim R, Oesterlein T, Graham L, Hogarth AJ, Page SP, Pepper CB, Rhode K, Lip GYH, Holden AV, Plein S, Tayebjee MH. 28Left atrial voltage predicts AF recurrence after ablation, irrespective of the rhythm during mapping, while circulating biomarkers of fibrosis do not. Europace 2017. [DOI: 10.1093/europace/eux283.037] [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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Hickman SE, Saunderson CED, Wilkinson E, Tayebjee MH. 116Survey to evaluate awareness and current practice of venous thromboembolism prevention following electrophysiological procedures in the United Kingdom. Europace 2017. [DOI: 10.1093/europace/eux283.110] [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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Battipaglia I, O’Neill J, Hogarth AJ, Tayebjee MH. Empirical anticoagulation for patients in sinus rhythm at high risk of ischaemic stroke: A review of current literature. World J Cardiol 2017; 9:422-428. [PMID: 28603589 PMCID: PMC5442410 DOI: 10.4330/wjc.v9.i5.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/25/2016] [Accepted: 03/22/2017] [Indexed: 02/06/2023] Open
Abstract
Ischaemic stroke is one of the commonest causes of morbidity and mortality worldwide and around a fifth of events can be attributed to a cardioembolic source. This is typically due to atrial fibrillation (AF), the most common sustained cardiac arrhythmia. However, AF can, at times, be difficult to detect due to a relative lack of symptoms and the fact that it can be paroxysmal in nature. Studies have shown that diagnosis of AF improves as the length of cardiac monitoring increases. However, prolonged cardiac monitoring is not a cost-effective way of diagnosing AF. Therefore, an alternative approach may be to empirically anticoagulate individuals who are at high risk of stroke. This article summarises current evidence surrounding stroke risk prediction, the use of anticoagulation in the secondary prevention of stroke and its use in the primary prevention of stroke in high risk groups with the aim of determining whether empirical anticoagulation is a safe and effective strategy.
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Abstract
Atrial fibrillation is the most prevalent cardiac arrhythmia, affecting 10% of those aged over 80 years. Despite multiple treatment options, it remains an independent prognostic marker of mortality due to its association with clinical sequelae, particularly cerebrovascular events. Management can be broadly divided into treatment of the arrhythmia, via rhythm or rate control, and stroke thromboprophylaxis via anticoagulation. Traditional options for pharmacotherapy include negatively chronotropic drugs such as β-blockers, and/or arrhythmia-modifying drugs such as amiodarone. More recently, catheter ablation has emerged as a suitable alternative for selected patients. Additionally, there has been extensive research to assess the role of novel oral anticoagulants as alternatives to warfarin therapy. There is mounting evidence to suggest that they provide comparable efficacy, while being associated with lower bleeding complications. While these findings are promising, recent controversies have arisen with the use of novel oral anticoagulants. Further research is warranted to fully elucidate mechanisms and establish antidotes so that treatment options can be appropriately directed.
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Affiliation(s)
- Peysh A Patel
- 1 Department of Cardiology, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - Noman Ali
- 2 Department of Cardiology, Bradford Royal Infirmary, Bradford BD9 6RJ, UK
| | - Andrew Hogarth
- 1 Department of Cardiology, Leeds General Infirmary, Leeds LS1 3EX, UK
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Begg GA, Karim R, Oesterlein T, Graham LN, Hogarth AJ, Page SP, Pepper CB, Rhode K, Lip GYH, Holden AV, Plein S, Tayebjee MH. Intra-cardiac and peripheral levels of biochemical markers of fibrosis in patients undergoing catheter ablation for atrial fibrillation. Europace 2017; 19:1944-1950. [DOI: 10.1093/europace/euw315] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/10/2016] [Indexed: 12/13/2022] Open
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Begg GA, Holden AV, Lip GY, Plein S, Tayebjee MH. Assessment of atrial fibrosis for the rhythm control of atrial fibrillation. Int J Cardiol 2016; 220:155-61. [DOI: 10.1016/j.ijcard.2016.06.144] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/11/2016] [Accepted: 06/24/2016] [Indexed: 01/26/2023]
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Battipaglia I, Gilbert K, Hogarth AJ, Tayebjee MH. Screening For Atrial Fibrillation In The Community Using A Novel ECG Recorder. J Atr Fibrillation 2016; 9:1433. [PMID: 27909536 DOI: 10.4022/jafib.1433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 12/24/2022]
Abstract
Aims: MyDiagnostick (MDK) is a novel portable ECG recorder. We conducted this study to evaluate its role in screening for atrial fibrillation (AF). Methods: The device is a cylindrical rod with metallic electrodes at both ends recording electrocardiogram (ECG) when both electrodes are held. Individuals were requested to hold the device for approximately 15 s, the device was then connected to a laptop (with proprietary software downloaded) and analysed. Anonymised ECGs were stored for further analysis. A total of 855 ECGs were recorded and analysed offline by two arrhythmia specialists assessing ECG quality, in particular the level of noise. A noise score (NS) was devised regarding ECG quality. Results: Seven individuals were found with unknown AF (0,8%). In general ECG quality was good and rhythm diagnosis was certain with total interobserver agreement. Conclusion: The MDK provided a rapid and accurate rhythm analysis and has potential implications in preventing ischaemic cardio-embolic stroke.
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Affiliation(s)
- Irma Battipaglia
- The West Yorkshire Arrhythmia Service, Leeds Teaching Hospitals NHS, Leeds, West Yorkshire, UK
| | - Katrina Gilbert
- The West Yorkshire Arrhythmia Service, Leeds Teaching Hospitals NHS, Leeds, West Yorkshire, UK
| | - Andrew J Hogarth
- The West Yorkshire Arrhythmia Service, Leeds Teaching Hospitals NHS, Leeds, West Yorkshire, UK
| | - Muzahir H Tayebjee
- The West Yorkshire Arrhythmia Service, Leeds Teaching Hospitals NHS, Leeds, West Yorkshire, UK
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Mercer BN, Begg GA, Page SP, Bennett CP, Tayebjee MH, Mahida S. Early Repolarization Syndrome; Mechanistic Theories and Clinical Correlates. Front Physiol 2016; 7:266. [PMID: 27445855 PMCID: PMC4927622 DOI: 10.3389/fphys.2016.00266] [Citation(s) in RCA: 6] [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] [Received: 03/24/2016] [Accepted: 06/15/2016] [Indexed: 12/20/2022] Open
Abstract
The early repolarization (ER) pattern on the 12-lead electrocardiogram is characterized by J point elevation in the inferior and/or lateral leads. The ER pattern is associated with an increased risk of ventricular arrhythmias and sudden cardiac death (SCD). Based on studies in animal models and genetic studies, it has been proposed that J point elevation in ER is a manifestation of augmented dispersion of repolarization which creates a substrate for ventricular arrhythmia. A competing theory regarding early repolarization syndrome (ERS) proposes that the syndrome arises as a consequence of abnormal depolarization. In recent years, multiple clinical studies have described the characteristics of ER patients with VF in more detail. The majority of these studies have provided evidence to support basic science observations. However, not all clinical observations correlate with basic science findings. This review will provide an overview of basic science and genetic research in ER and correlate basic science evidence with the clinical phenotype.
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Affiliation(s)
- Ben N Mercer
- West Yorkshire Arrhythmia Service, Leeds General Infirmary Leeds, UK
| | - Gordon A Begg
- West Yorkshire Arrhythmia Service, Leeds General Infirmary Leeds, UK
| | - Stephen P Page
- West Yorkshire Arrhythmia Service, Leeds General InfirmaryLeeds, UK; Regional Inherited Cardiovascular Conditions Service, Leeds General InfirmaryLeeds, UK
| | - Christopher P Bennett
- Regional Inherited Cardiovascular Conditions Service, Leeds General Infirmary Leeds, UK
| | | | - Saagar Mahida
- West Yorkshire Arrhythmia Service, Leeds General InfirmaryLeeds, UK; Regional Inherited Cardiovascular Conditions Service, Leeds General InfirmaryLeeds, UK
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Ullah W, McLean A, Tayebjee MH, Gupta D, Ginks MR, Haywood GA, O'Neill M, Lambiase PD, Earley MJ, Schilling RJ. Randomized trial comparing pulmonary vein isolation using the SmartTouch catheter with or without real-time contact force data. Heart Rhythm 2016; 13:1761-7. [PMID: 27173976 DOI: 10.1016/j.hrthm.2016.05.011] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Contact force (CF) information may improve the safety and efficacy of ablation for paroxysmal atrial fibrillation (PAF). OBJECTIVE The purpose of this study was to assess the impact of CF data on ablation for PAF. METHODS Patients undergoing first-time PAF ablation were randomized at 7 UK centers to ablation with (CF-on) or without (CF-off) CF data available to the operator, using the same ablation catheter and mapping system. An ablation CF of 5-40g was targeted. Pulmonary vein (PV) reconnection was assessed with adenosine at 60 minutes. Follow-up for arrhythmia recurrence was for 1 year with 7-day Holter recordings at 6 and 12 months. RESULTS One hundred seventeen patients were studied (59 CF-on, 58 CF-off). In the CF-on group, a reduction in acute PV reconnection rates (22% vs 32%, P = .03) but no significant difference in 1-year success rates off antiarrhythmic drugs (49% vs 52%, P = .9) was observed. There was no difference in major complication rates: 2 of 59 (3%) CF-on, 3 of 58 (5%) CF-off (P = .7). Procedural and fluoroscopy times were not significantly different (P>.5). Overall mean CFs per ablation were not different between groups (13.4 [9.1-19.6]g CF-on, 13.4 [7.4-22.4]g CF-off, P = .5), but a greater proportion of readings in the CF-on group were in the target range (80% vs 68%, P<.001). CONCLUSION This randomized multicenter study demonstrated that CF data availability was associated with reduced acute PV reconnection but not improved 1-year success rates, procedural and fluoroscopy times, or complication rates. There was a reduction in extremes of CF, above and below the study target range, suggesting greater CF control during ablation.
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Affiliation(s)
- Waqas Ullah
- Cardiology Research Department, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.
| | - Ailsa McLean
- Cardiology Research Department, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | | | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Guy A Haywood
- Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - Mark O'Neill
- Cardiovascular Division, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Mark J Earley
- Cardiology Research Department, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Richard J Schilling
- Cardiology Research Department, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
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A N, Schlosshan D, Ahmed I, Tayebjee MH. Development Of A Novel Scoring System That Determines The Success Of Atrial Fibrillation Ablation As Part Of Cardiac Surgery. J Atr Fibrillation 2015; 8:1269. [PMID: 27957207 DOI: 10.4022/jafib.1269] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 08/15/2015] [Accepted: 08/20/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Radiofrequency ablation therapy for the treatment of atrial fibrillation (AF) can be performed as a concomitant procedure alongside cardiac surgery, but carries the risks of increased bypass time and damage to the sinoatrial node. This study aims to assess the efficacy of concomitant surgical AF ablation and develop a novel scoring system to predict post-procedural return to sinus rhythm. METHODS A review of the Leeds General Infirmary surgical database was conducted to list all patients who had undergone valvular or coronary bypass surgery with concomitant AF ablation between Jan 2012 - Dec 2013 (n = 76). Follow-up was obtained retrospectively using patient notes, clinic letters and echocardiographic data. Primary outcome was freedom from AF at median follow up (383 days). A novel scoring system was created through analysis of previous literature and evaluated using a receiver operating characteristic (ROC) curve. RESULTS At median follow up 50.9% of patients undergoing the procedure were free from AF. The novel scoring system was shown to adequately predict post-procedural return to sinus rhythm (ROC AUC = 0.7708). CONCLUSION A novel scoring system was shown to predict procedural success in patients undergoing concomitant AF ablation alongside cardiac surgery. These results can be further validated using larger patient cohorts.
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Affiliation(s)
- Norton A
- Brighton and Sussex Medical School, Royal Sussex County Hospital, Eastern Road, Brighton
| | - D Schlosshan
- Department of Cardiology, Leeds General Infirmary
| | - I Ahmed
- Royal Sussex County Hospital, Eastern Road, Brighton
| | - M H Tayebjee
- Department of Cardiology, Leeds General Infirmary
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Sandoe JAT, Barlow G, Chambers JB, Gammage M, Guleri A, Howard P, Olson E, Perry JD, Prendergast BD, Spry MJ, Steeds RP, Tayebjee MH, Watkin R. New guidelines for prevention and management of implantable cardiac electronic device-related infection. Lancet 2015; 385:2225-6. [PMID: 26088482 DOI: 10.1016/s0140-6736(14)62249-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Gavin Barlow
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | | | | | - Philip Howard
- University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - Ewan Olson
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Michael J Spry
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Richard P Steeds
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Muzahir H Tayebjee
- University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
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Patil SBG, Tayebjee MH. Other antihypertensives. Hypertension 2015. [DOI: 10.1093/med/9780198701972.003.0017] [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]
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Sandoe JAT, Barlow G, Chambers JB, Gammage M, Guleri A, Howard P, Olson E, Perry JD, Prendergast BD, Spry MJ, Steeds RP, Tayebjee MH, Watkin R. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). J Antimicrob Chemother 2014; 70:325-59. [PMID: 25355810 DOI: 10.1093/jac/dku383] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Infections related to implantable cardiac electronic devices (ICEDs), including pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy devices, are increasing in incidence in the USA and are likely to increase in the UK, because more devices are being implanted. These devices have both intravascular and extravascular components and infection can involve the generator, device leads and native cardiac structures or various combinations. ICED infections can be life-threatening, particularly when associated with endocardial infection, and all-cause mortality of up to 35% has been reported. Like infective endocarditis, ICED infections can be difficult to diagnose and manage. This guideline aims to (i) improve the quality of care provided to patients with ICEDs, (ii) provide an educational resource for all relevant healthcare professionals, (iii) encourage a multidisciplinary approach to ICED infection management, (iv) promote a standardized approach to the diagnosis, management, surveillance and prevention of ICED infection through pragmatic evidence-rated recommendations, and (v) advise on future research projects/audit. The guideline is intended to assist in the clinical care of patients with suspected or confirmed ICED infection in the UK, to inform local infection prevention and treatment policies and guidelines and to be used in the development of educational and training material by the relevant professional societies. The questions covered by the guideline are presented at the beginning of each section.
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Affiliation(s)
| | - Gavin Barlow
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | | | | | - Philip Howard
- University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ewan Olson
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Michael J Spry
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Richard P Steeds
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Ma'touq J, Strauss DN, Messenger N, Stewart TD, Tayebjee MH. Spinal angle and foot pressure during cardiac electrophysiological procedures. Int J Cardiol 2014; 172:e398-400. [PMID: 24452225 DOI: 10.1016/j.ijcard.2013.12.260] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 12/30/2013] [Indexed: 11/18/2022]
Affiliation(s)
- J Ma'touq
- Institute of Medical and Biological Engineering, Faculty of Engineering, University of Leeds, UK
| | - D N Strauss
- Sports and Exercise Sciences, Faculty of Biological Sciences, University of Leeds, UK
| | - N Messenger
- Sports and Exercise Sciences, Faculty of Biological Sciences, University of Leeds, UK
| | - T D Stewart
- Institute of Medical and Biological Engineering, Faculty of Engineering, University of Leeds, UK
| | - M H Tayebjee
- West Yorkshire Arrhythmia Service, Department of Cardiology, Leeds General Infirmary, UK.
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Hogarth AJ, Dobson LE, Tayebjee MH. During ablation for atrial fibrillation, is simultaneous renal artery ablation appropriate? J Hum Hypertens 2013; 27:707-14. [PMID: 23945464 DOI: 10.1038/jhh.2013.75] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/10/2013] [Accepted: 07/12/2013] [Indexed: 01/12/2023]
Abstract
Over the past few decades, the mainstay of hypertension management has been pharmacological therapy; however, there is now a growing body of evidence that drug-resistant hypertension can be managed effectively by renal artery ablation. Several studies have documented the feasibility and safety of this treatment, although data regarding long-term outcomes are still emerging. Atrial fibrillation (AF) and hypertension commonly coexist, and recent work has demonstrated improved outcomes from catheter ablation of AF with concomitant renal artery denervation at little extra cost in terms of time and resource. The aim of this review is to explore the link between hypertension and AF, the synergistic effect of renal artery ablation on AF ablation, explain how this may work and address unanswered questions.
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Affiliation(s)
- A J Hogarth
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
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Tayebjee MH, Joy ER, Sandoe JA. Can implantable cardiac electronic device infections be defined as ‘early’ or ‘late’ based on the cause of infection? J Med Microbiol 2013; 62:1215-1219. [PMID: 23699068 DOI: 10.1099/jmm.0.057042-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Implantable cardiac electronic device (ICED) infections are a major cause of morbidity and mortality. Understanding the pathogenesis of these infections is important in their prevention and management. We hypothesized that ICED infections could be classified as ‘early’ or ‘late’, based on differences in microbiological cause within or beyond 1 year of implantation, respectively. A comprehensive review of the literature was undertaken to test this hypothesis. Prosthetic valve endocarditis cases were included for comparison. Articles were included if the time from device implantation to infection, definite evidence of infection (pocket/bacteraemia/endocarditis) and a positive microbiological diagnosis were included. There were no statistically significant differences in microbiology to support a 1 year cut-off between early and late ICED infection. Staphylococcus aureus and coagulase-negative staphylococci were the predominant causes of ICED infection both within and beyond 1 year of ICED implantation. To further assess the microbiological causes of ICEDs and their implications for pathogenesis a large-scale multi-centre study is required.
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Affiliation(s)
- Muzahir H. Tayebjee
- Department of Cardiology, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - Eleanor R. Joy
- Department of Cardiology, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
| | - Jonathan A. Sandoe
- Department of Microbiology, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
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Simms AD, Hogarth AJ, Hudson EA, Worsnop VL, Blackman DJ, O'Regan DJ, Tayebjee MH. Ongoing requirement for pacing post-transcatheter aortic valve implantation and surgical aortic valve replacement. Interact Cardiovasc Thorac Surg 2013; 17:328-33. [PMID: 23620339 DOI: 10.1093/icvts/ivt175] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve implantation (TAVI) is an established intervention for aortic stenosis. While it is known that the requirement for permanent pacing is higher following CoreValve (Medtronic, Inc., Minneapolis, MN, USA) TAVI than after surgical aortic valve replacement (SAVR), it remains uncertain whether pacing is required in the medium-to-long term. We hypothesized that complete heart block following TAVI is more likely to resolve than that following SAVR. METHODS A retrospective analysis of prospectively collated data on 528 patients undergoing TAVI or SAVR from May 2008 to December 2010 at a cardiac tertiary referral hospital. Demographic data, timing and indication for pacing post-procedure plus follow-up were recorded. Paced patients were compared and analysed by existing initial indication for pacing. RESULTS In total, 31 (5.9%) patients received a pacemaker, and there were limited differences between not paced and paced patient characteristics by procedure type. Of these, a greater proportion were implanted post-TAVI compared with SAVR (17 vs 3.2%, P<0.001). The mean time to pacemaker follow-up for TAVI and SAVR was 234 and 188 days, P=0.32, respectively. Fewer patients compared with pacing indication remained in complete heart block at latest follow-up for TAVI (76.5 vs 33.3%, P=0.02) and SAVR (92.9 vs 58.3%, P=0.04). Although, there was a trend towards a greater magnitude of TAVI patients regaining atrioventricular nodal conduction, this did not differ significantly from that seen in SAVR patients. CONCLUSIONS In keeping with previous reports, this single-centre experience demonstrates that patients undergoing TAVI have higher rates of pacemaker implantation than those following SAVR. However, pacing indication in the short-to-medium term may not persist for all paced patients post-TAVI and -SAVR with the suggestion that a significant proportion recover atrioventricular conduction, which tended to be greatest in TAVI paced patients.
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Mahida S, Hogarth AJ, Cowan C, Tayebjee MH, Graham LN, Pepper CB. Genetics of congenital and drug-induced long QT syndromes: current evidence and future research perspectives. J Interv Card Electrophysiol 2013; 37:9-19. [PMID: 23515882 DOI: 10.1007/s10840-013-9779-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [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: 11/06/2012] [Accepted: 01/07/2013] [Indexed: 12/17/2022]
Abstract
The long QT syndrome (LQTS) is a condition characterized by abnormal prolongation of the QT interval with an associated risk of ventricular arrhythmias and sudden cardiac death. Congenital forms of LQTS arise due to rare and highly penetrant mutations that segregate in a Mendelian fashion. Over the years, multiple mutations in genes encoding ion channels and ion channel binding proteins have been reported to underlie congenital LQTS. Drugs are by far the most common cause of acquired forms of LQTS. Emerging evidence suggests that drug-induced LQTS also has a significant heritable component. However, the genetic substrate underlying drug-induced LQTS is presently largely unknown. In recent years, advances in next-generation sequencing technology and molecular biology techniques have significantly enhanced our ability to identify genetic variants underlying both monogenic diseases and more complex traits. In this review, we discuss the genetic basis of congenital and drug-induced LQTS and focus on future avenues of research in the field. Ultimately, a detailed characterization of the genetic substrate underlying congenital and drug-induced LQTS will enhance risk stratification and potentially result in the development of tailored genotype-based therapies.
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Affiliation(s)
- Saagar Mahida
- Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK.
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Lowe E, Tayebjee MH, Pratty J, Sandoe JA. Survey of antibiotic prophylaxis for implantable cardiac electronic device (ICED) insertion in England. Int J Cardiol 2012; 157:286-7. [DOI: 10.1016/j.ijcard.2012.03.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 03/08/2012] [Indexed: 10/28/2022]
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Tayebjee MH, Tyndall K, Holding S, Russell C, Graham LN, Pepper CB. South Asians are Under-Represented in a Clinic Treating Atrial Fibrillation in a Multicultural City in the UK. J Atr Fibrillation 2012; 4:440. [PMID: 28496714 DOI: 10.4022/jafib.440] [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] [Received: 10/20/2011] [Revised: 11/14/2011] [Accepted: 11/17/2011] [Indexed: 11/10/2022]
Abstract
The Leeds rapid access atrial fibrillation (AF) clinic was set up to streamline and standardise management of patients with newly diagnosed AF. Anecdotal evidence suggests that there is under-representation of south Asians in these clinics.All patient attendances between June 2007 and June 2011 were documented and combined with ethnicity data from patient administration records. Local population demographics for 2009 were obtained from the office of national statistics. This was used to estimate the expected prevalence of AF across the different ethnic groups in Leeds taking age into account. One thousand two hundred and ten patients were referred. The study sample included 992 patients, and the number of south Asians attending was 88% less than expected (Chi squared analysis; p<0.0001). These results suggest that there is an under-representation of south Asians in a large centre that serves a cosmopolitan population. Potential reasons for this discrepancy including barriers to accessing treatment for this population or a lower prevalence of AF in south Asians due to an as yet unidentified genetic factor.
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Affiliation(s)
- M H Tayebjee
- Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, United Kingdom. LS1 3EX
| | - K Tyndall
- Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, United Kingdom. LS1 3EX
| | - S Holding
- Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, United Kingdom. LS1 3EX
| | - C Russell
- Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, United Kingdom. LS1 3EX
| | - L N Graham
- Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, United Kingdom. LS1 3EX
| | - C B Pepper
- Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, United Kingdom. LS1 3EX
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Showkathali R, Tayebjee MH, Grapsa J, Alzetani M, Nihoyannopoulos P, Howard LS, Lefroy DC, Gibbs JSR. Right atrial flutter isthmus ablation is feasible and results in acute clinical improvement in patients with persistent atrial flutter and severe pulmonary arterial hypertension. Int J Cardiol 2011; 149:279-280. [DOI: 10.1016/j.ijcard.2011.02.059] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 02/25/2011] [Indexed: 11/28/2022]
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Tayebjee MH, Creta A, Moder S, Hunter RJ, Earley MJ, Dhinoja MB, Schilling RJ. Impact of angiotensin-converting enzyme-inhibitors and angiotensin receptor blockers on long-term outcome of catheter ablation for atrial fibrillation. Europace 2010; 12:1537-42. [PMID: 20682557 DOI: 10.1093/europace/euq284] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Muzahir H Tayebjee
- Cardiology Research Department, Barts and The London NHS Trust and QMUL, St Bartholomew's Hospital, First Floor Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A 7BE, UK.
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Tayebjee MH, Duncan E, Baker V, Dhinoja M, Earley MJ, Sporton S, Schilling RJ. 135 Combined radiofrequency and cryoablation for paroxysmal atrial fibrillation. A novel technique to reduce recurrences: Abstract 135 Table 1. Heart 2010. [DOI: 10.1136/hrt.2010.196113.4] [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: 11/03/2022]
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